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3222 Evergreen DrS ? 2?Lol 2006 RESIDENTIAL BUILDING rERI?uT arrLicaTroN C ?A 3.S City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New ConsW ction Reauirements RemodeVReoair Reauirements Office?llse'Onlv 3 registered si[e survzys showing sq. ft of lot sq. ft of house; and all roofed areas 2 copies of plan showing foolings, beams, joists CeR of Survey Retd - Y_ N (20% maximum iM coverage allowed) 1 set of Energy Calculations for heated additions Tree Pres Plan Reoj _ Y_ N, 2 copies of pian showing beam & window sizes; poured fouM design, etc. i site survey for addNOns & decks Tree Pres Required -_Y _ N 1 setotEnefgyCalculations Addifion - indicafeifon-sdesepticsystem OnsiteSepticSystem _Y _N 3 copies of Tree PreservaGon Plan if lot piatted aRer 711193 Rim Joist Detail Options selection sheet (buildirigs with 3 or Iess unifs) . Minnegasco mechanical ventilation fortn Date 11_ / ?' Construction Cost Site Address 1 G 6,t?? bY . UniUSte # a- VZI S zzzo 3zz2 ?zzy 3zz4 Description of Work ??IqLI'qye14 LV1j 6u1S Multi-Family Bldg ? Y_ N Fireplace(s) _ 0 _ 1 _ 2 Property Owner 0011K-0mAA) 46J 411W 1 ??4?&te5 Telephone# a IF ? '? S ? ? ApR JU/ ? ? ?Q??fi Contractor ?AISSqI'1CQ 7? ??()? waaress 235? ,f kluoocll ty, ? 13v city Ak ??ove State M? Zip 75?3LCl, Telephone #(?3 ) f?3' ov-/'/ COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 Cateeorv 1 _ Minnesota Rules 7672 Energy Code Category , Residential Ventila6on Category 1 Worksheet • New Energy Code Worksheet (4 submissiontype) Submitted Submitted . Energy Envelope Calculations Submitted In the last 12 monihs, has The City of Eagan issued a permit for a similar plan based on a master plan? _ Y _ N If yes, date and address of master plan: Licensed Plumber Mechanical Contractor Sewer/Water Contractor Telephone # ( Telephone # ( Telephone # ( ) I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. t/l/ui 2 2du ?I`lh ?jqrr? ` Appiicant's Printed Name Applicant's Signature '7?Lu -73 zoos RESIDENTIAL PLUMBING PeRnnir aPPUCaTioN CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN MN 55122 651-675-5675 Please complete for modifications to existing residential dwellings. ? Date!L- /1A i Site Street Address Unit # Property Owne&(cr, U -f Telephone # (N) ? . Contractor )s?` i s Telephone #(h ) __ ?-_?? ,,D Address City !F:a SWte Zip? i The Applicant is: _ Owner k_ Contractor _Other Septic System _ New _ Refurbished Submit 2 sets of plans and MPC license Includes County fee ? $ 100.00 Per as-built $ 10.00 ! Alterations to existing dwelling $ 50.00 _ Add plumbing fixtures. This fee includes installation of a water softener andlor water heater at the same time. !f you are installing onlv a water sokener and/or water heafer, do not complete this section; move to the next section and check the appliance(s) you are installing. ? -Septic System Abandonment i ` _Water Turnaround (add $130.00 if a 518" meter is required) Other: _ Water Softener ? Water Heater $ 15.00 _ new -31 replacement i I Lawn Irrigation _RPZ _PVB _new _repair _rebuild $ 30.00 ? ' State Surcharge $ 50 Total ? I hereby apply for a Residential Plumbing Permit and acknowledge that the information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and the plumbing codes; that I understand this is not a permit, but only an application for a permit, work is not to start without a.permit and work wi1! be in accordance with the approved plan in the event a plan is re ired to be review 4I and approv:.d. ?r%M?I1P, ?rrC Applicant' Printed Name pplicanY Signature "Q ? v E{ i ?..1 1' te !. U. %'i N * 111'PISCNI'iON WL5 N,?T CU:1132I1Jli . * APPROVAL OF PEEtNffT: +'. APPLICATION FOR PERMiT *i_NSPBCTION oF MaM Arm/Ot MUM ; . ' • ' ` . ?"r%' .' ?a y?. 7IISmAT.T.ATTON$ WIIS, NO'P BE .°iCH@= . ; SEWER AND/OR WATER CONNECTION ? ?ID ?II+ P?M?T ? B? • . * APPROVFD. • ? . . . , . . ,' ? . ' y*, - . . _ . _ ..'; .. , * . . ' . • .:.: ; ;; . .. ? - ..... . ' ***#****+:**??**?***??,r***t*t3:*#**? . ?ca.cooc rllaa?l.)?, ' . . ? 1) PROPERTY. ADDRESS: LEGAL DESCRIPTION: 4QT S•?. , ?/ Jy??/ / , C1'A,Q/??/??? ?)? ?r. Lot lock?jSUbdivision or Tax Parcel,-ID ) IF EXISTING SPRCCIL'RE,v DATE OF ORIGINAI, BI?ILDING PER6IIT ISSL'ANCE: PRESENr 2ANING/PROPOSr.'D USE: (Mon Year) q W24a2CIAL,1ETAIL/0FFICE _ ?. R-1 SINGLE FAMILY . . 0 IN[)CSTRIAL R-2 DPPLEX (Twu C?nits) . .. n INSTIZL"fIONAL/GOVERf.^ENT ' ?-3 TOWNiOC?5E (Three + Units) Dnits). . Q R-4 APARTT?TT/COI?IDOyLiNlUM (.. Units) Zr ADDRESS: CITY, STATE, ZIP: PHO?: oC So7 ? ? ? 3) NADSE: GERTZ-RYAN PLUMBIIdG AND HEATING ADDRESS: 14745 South Robert Trail CITY, STATE, ZIP: RosemounEz IPI 55068 FHONE: 423-1144 MASTER LICENSE$ 1849M • Plumbers License: Active F?cpired Not recorded Sta II11t1c11 q) oee • o , i?+• NAhE: . . . , . . _ P.DDRFSS: • . CI1'Y, STATE. ZIP: ' PHDiNE: • 5) - t,? iu•v?:, •?rc-.?.-? iu?.. •-?r,rr-ecr t4 ? z ? C0?^ ?I?ECi'I0.4 M CITY SEL•1II2 ? CONNECTION 'IU CITY 4;ATER ? 0= '.• • . 6) PL 7-_:%sE HOLD APPROV ED Pt?`'-',IT FOR PICK-L'P IIY 0'IE OF P.3OVE -' -- ._ PLEA,, .•:?IL ApPROVID PE2:1IT 7) 1, 2, 3 4, AEOVE (Circle one) 7) r?:?: k I.l 1 N/ II!__Y C1+/I1, ( I CC A Vl j,; ? D? ?? Ir l;J' I ItfC '.?Q?? ^?'?7 FOR CITY USE ONLY PERMIT # ISSL'Ep Pd w/Bldg. Permit FEES: $ $ SEWER PERMIT (INCLDDE SURCHARGE) $ $ /t'' WATER PERMIT (INCLUDE SURCHARGE) $ L%? 5-D $ WATER METER/COPPERHORN/OL'TSIDE READER $ $ WATER TAP (INCLL'DE CORPORATION STOP) $ $ SEWER TAP $ S /5 • ?"--c+ ACCOUNT DEPOSIT - SEWER $ $ ?J • ??? ACCOUNT DEPOSIT - WATER S E J d?. OZ3 $ WAC ' sAc $ S TRLNK WATER ASSESSMENT $ $ TRLNK SEWER ASSESSMENT $ S LATERAL BENEFIT/TRUNK SEWER $ $ LATERAL BENEFIT/TRUNK WATER $ / ??•? ? $ WATER TREATMENT PLANT SURCHARGE .. $ i ' S , 'OTHER: - $ / 4 TOTAL CO??7,5 ,. . --- ?RECEIPT REC$IPT DOES UTILITY COIVNECTION REQLIRE EXCA VATION IN PUBLIC RIGHT OF WAY? ? YES IF YES, THEN A" PERMIT FOR WORK WITHIN PU$LIC ? ROADWAY" MOST BE ISSUED BY THE ENGINEERING NO DIVISION. LIST AS A CONDITZON. SUBJECT TO THE FOLLOWIN6 CbNDSTIONS: ? A PPROVED BY: ` Jl / -c_?-__. ,< L•:-Z.t17?-?/ - . . . . TITLE: r .. . ?, ; . . . ... . ;DATE: / /'7 li /'7 ,?• BUILDING PERMIT TYPE ? 01 Foundation ? 18 Comm./lnd. WORK TYPE ? 31 New ? 32 Addition GENERAL INFORMATION Const. (Actual) (Allowable) UBC Occupancy Zoning # of Stories Length Depth APPROVALS Planning ? 19 Comm./Ind. Misc. 0 20 Public Facility ? 33 Alterations ? 34 Repair Basement sq. ft. First Floor sq. ft. sq. ft. sq. ft. sq. ft. sq. ft. Footprint sq. ft. Building Engineering ? 21 Miscellaneous ? 35 Tenant Finish ? 37 Demolition MC/UVS System City Water Fire Sprinklered Census Code SAC Code Census Bldg. Census Unit Variance Permit Fee 1_Y1- ahs' Surcharge LI ? C7 Plan Review MCNVS SAC City SAC Water Conn. S/W Permit S/W Surcharge Treatment PI. Park Ded. Trails Ded. Water Qual. Other Copies Total: ??I•?s % SAC 5AC Units Meter Size _ Valuation: $ 1998 BUILDING PERMIT APPLICATION (COMMERCIAL) CITY OF EAGAN 681-4675 ? bt ' ermit i?-i-1 1 9? ubmd following to o ain necessary p Foundation Only New Construction . Interior Improvement stmctural plans (2 sets) architectural plans (2 sets) architectural plans i l (2 sets) (?) ° ciail plans (2 sets) structurel plans (2 sets) ys s wde ana t (1 set) code analysis (1) " civil plans (2 sets) specs projec soils report (1) landscaping plans i l (2 sets) (7) " Key Plan energycalculations (7)notalways ° projectspecs (1) Special Inspections & Testing Schedule " codeana ys s soils report (1) Electric Power & Lighting Form (1) not always SAC determination letter from MC/WS - SAC determination letter from MClWS - SAC determination letter from MCNVS - call 602•1000 call 602-1000 wil 602-1000 Special Inspections & Testing Schedule(1) " . project specs (1) energycaiculations (1) Electric Power 8 Lighting Fortn (1) " ° Gontact ttwiaing mspecnons ror sampie Food 8 Beverage or Lodging facilities: Plan must be submitted to Minnesota Department of Health. Call 215-0700 for details. DATE: -9e WORK TYPE: _ NEW riREMODEL DESCRIPTION OF WORK: o7? v CONSTRUCTION COST: G , UU ? SITE ADDRESS: 3a1 32 0, 3-2 2-a , LOT ? BLOCK I SUBD. r, r ?t w?2?? PROPERTY Ias[ OWNEIt S7eet City Statc: Phone # Zip: Company: ?'e-\ S?V \ l. )i V?CU6 C 1'4 ?uQ ? n x._ Phone ?S ? ROi ITRAC'I'O Street Address: ??3 ?_?4?? ?•?"?'S 0 h f?V?f._ License _-?- City State: ZiP: ARCHITECT/ ENGINEER Slrecl City Sewer & water licensed plumber (only if installing sewer & water): Phottc #: ___ Regisuation #: _ State: Zip: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State oi Minnesota Statutes and City of Eagan Ordinances. rirst TENANT NAME SUITE 3aa?i ?a-a- ?,e }}t ?? P.I.D. # Signature ot Applicant: OFFICE USE ONLY ? PERMIT ? CITY P oOF EAGAN PERMIT TYPE: e u rL o z N e Eagan, Minnesota 55122-1897 Permit Number: 0 3 q 0 4 6 (651) 681-4675 Date Issued: 11 / 17 / 9 8 SITE ADDRESS: 3216 EVERGREEN DR LGT: 54 t3LOCK: 1 COACHMAN I-IT(;lil.ANLIS P.S.N.: 1.0-1.8015-540-01 DESCRIPTION: ' REROOF,I' 6 FLEX Bu31d3.nq Perm3t 'iype MUL7I. (MTSC.) Building Work,,l'vpQ F?EPAIR Census Code . 4:34 AI.i'. REB:[DENTIAL REMARKS: INCLUDES: 3218. 3220. 3222. 3224. AND 3226. FEE SUMMARY: VALUA7ION y:8.000 8ase f=ee $137.25 Surcharge 4._e4, Total Fee ? $141.25 CONTRACTOR: - A pp1 i ra„T: - OWNER: BE,LSSEL WINDQW & SIpING 2451.6835 COACHhIRN HZGNt.NNDS ASSOC. 3213 EV['RGREEN DR 3116 EVERGkEEN DR EAGAN MN 551.21 EAGFlN MN 55122 (6q2) 451-6835 I hereby acknowledae that I have read this application and state that the information is correct and agree to c:omply with all applicabla Stata ofi Mn. L 9tatutes and City o'P Eagan Ordirrances> APPIICANT/PEFMITEE SIGNATURE ISS O BY. SIGNATURE? ` J ? 1985 BUILDING PERMIT APPLICATION - CITY OF EAGAN NOTE: ALL CONTRACTORS NUST BE LICENSED YIITH THE CITY OF EAGAN COl41ERCIAL SINGLE FAMILY DNELLINGS INCLUDE 2 SETS OF ARCHITECTURAL INCLUDE 2 SETS OF PLANS & STRUCTURAL PLANS, 1 SET OF 3 CERTIFICATES OF SURVEY SPECIFICATIONS AND 1'SET OF 1 SET OF ENERGY CALCULATIONS ENERGY CALCULATIONS $2,000 LANDSCAPE BOND . To Be Used For: :iaif i Site Address off"/6"-J,226 Lotl7 S7 Block / Parcel/Sub Owner Valuation: , 3 4 " Address ? City/Zip Code ? v` ?73L Phone Contractor .? G??Jf -.a, Address City/Zip Code Phone Areh./Engr. ? Address City/Zip Code Date: Erect 1 Occupancy Remodel Zoning Repa3r ? Type of Const Addition 6 of Stories Move , Length Demolish Depth Int.Impr. Sq Ft Install APPROYALS FEES Assessments Permit Water/Sewer ? Surcharge Police Plan Review Fire SAC Engr Water Conn Planner Water Meter Council Road Unit Bldg Off Treatment P1 APC Parks Variance Copies TOTAL Phone U .. . I)rIZ1a ? 1985 BUILDING PERMIT APPLICATION - CITY OF EAGAN NOTE: ALL CONTRACTORS MUST BE LICENSED HITH THE CITY OF EAGAN GI -za2 COMMERCZAL INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS $2 000 LANDSCAPE BOND SINGLE FAMILY DSiELLINGS INCLUDE 2 SETS OF PLANS 3 CERTIFICATES OF SURVEY '1 SET OF ENERGY CALCULATIONS 9 L,ZGknc:? To Be Used For: TOWnhOUSe Valuation:Date: 4/8/86 Site Address 3222 Evergreen Drive Lot 57 Block 1 Parcel/Sub Coachman Highlands Owner Brutger Companies, Inc. Address One Sunwood Dr., P.O. Box 399 City/Zip Code St. Cloud, MN 56302 OFFICE USE ONLY Erect ? Occupancy ? Remodel Zoning Repair , Type of Const ? Addition /1 of Stories Move ' I.ength 71 Demolish , Depth Int.Impr. Sq Ft Install Phone 612/252-6262 contractor Brutger Companies, Inc. Address One Sunwood Dr., P.O. Box 399 City/Zip Code St. Cloud, MN 56302 Phone 612/252-6262 Arch./Engr. Blumentals Architects, Inc. Address 6100 Summit Drive North City/Zip Code Brookl.yn Center, MN 55430 Phone 11612/571-5550 APPROVALS FEES Assessments Permit 31`1• Water/Sewer Surcharge 31. Police ' Plan Review 159• Fire SAC SS, Engr Water Conn ScO Planner Water Meter (03' Council Road Unit Zqa Bldg Off Treatment P1 15(? APC Parks Variance Copies ? TOTAL . L? 5 C /.SS/ 8' m 8444 ?-?°° RByuasi Date r Frte Na. Rouqh-in In9pacli6n Recuired? ? ? ReaCY Now I ?or R Wh ? Vas C No en eeM f 1,0 licensed contrac[or owner hereby request inspection of above electricat work at: bE Atltlress (Street, Boz or ftoute N0.) Ciry $ection No. Township Nama or No. Range No. Couny{?(? l? ? `?fIV?V 1 ' Y Occupdnt (PAINT) Phoria No. PowerSapplier ?, ` p 1v:y 1 Atltlress ElBttmal Cpnh3Ctor (COmpdny Name) CAnh8tIM4 LiCBflae NO. ' MBiling AWress (COntrector or Ownar Making Iretatlation) Aullwnze0 SgnaWre (ConV ner ry'n tallatlon) Phorw Number ?sy ,7- MINNESOTR STRTE BOppD OF ELECTRICITY TMIS INSPECTION REOUEST WILL NOT Grlypii-MWway BWp. - Hoom S173 - BE NCCEPTED BY THE STATE BOARD 1871 UnHnNty Ave., SI. Paul, MN 55704 UNLESS PROPER INSPECTION FEE IS Vlana (812) W24800 ENCLOSED. s/?ofgi a_38444 REQUEST FOR ELECTRICAL INSPECTION ?$ea instmqions tor completing 1hi5 form on beck of yellaw copy. 'X" Balaw Work Covered by This Request nEa.OODO,-06 Add Rep. TypeolBuilding AppllancesWired EquipmentWired Home Range Temporary Service Duplex Water Hearer Electric Heatinq ' Apt Building Dryer Other (Speciy) Comm.llntlustrial ' Fumace ?' JjC V.l j ?.J Fafm Air Conditioner Olher ?specj(y)u? CpnVactwk Remerks: ?wh?ra Compute Mspection Fee Below: N Other Fee # ServiceEntrenceSize Fee # Circui15/Feeders Fee Swimming Pool 0 to 200 Amps 0 to 100 Amps Transformers Above 200 _ Amps ve Amps Slgns Inspeclor§ use onry: O? TOTAL Z-0 Irrigation Booms X' p?Q Special InSpection Alarm/COmmunication THIS INSTALLATION MAY BE ORD DISCONNECTED If NOT Other Fee COMPLETED WITHIN 18 M 7915. I, the Electrical Inspector, hereby certify that the above inspection has been made. Rough-in OFFlCE IISE UNIY This requegl wi0 18 months hom This request voitl / _ ? 78 monffis fmm ?? 9 M 0 9 6 3 23 LS -? 13 /On--,-4&l,O..,,At 5`7 - Remnesi Q.te `f Fire No. RouBh-in Insoecifon Re?uired? ' oFleady Nuw [g'R'ili No?ity, Insoeo 1or Wh F !( 0 9-1 es ?NO ¢n eatly D Licensed ElecVical ConVactor 1 hereby request inspactian of above Q Owner electrical work installed a[: - Street Address, Box or Route No. 222 ?-?t I?en DY?? ? C?tY ?d ecuon o. I Township N2me ? ' No. . Range No. Covnty??- y?]? T?,? alil.t ? V ' `-'I Occupxnt IPFINTI Ccociiiman 10110l5 Phone No. Paw r 3upDl- r Address . ? f. /117 E. ect ical ConVactor ICom amel C CunhacYn 's License No. ailinB ddress (ConVacto or Owne f ak!ing Instat{i9^ /L Ul. Uf /? U /?//, Au h n na r IC ntrac Ow r ak' is allation) Ph e Numbo???? MINNESOTA STATE BOAflD OF ELECTflIGITV? THIS INSPECTION REQVEST WILL NOT Griggs-Midwey Bldg. - Room N-791 gE ACCEPTED eY THE STATE BOAPD 1821 Univeniry Ave., SL Paul, MN 65104 UNLESS PflOPER INSPEC710N FEE IS Phone 16121297-2111 ENCLOSED. ee REQUEST FOR EIECTRICAL INSPECTION „ -ooom-cu w ? Sae ins<ructions (or completing this fwm on back of yellow wpy. o 096325 "X'* Below Work Covered by This Request AAd Bap. Type ot 8uiltlin9 Applipnces Wired EQUiument Wired Bulk Milk M iea SarviceEntrenceSize p Fee Fanders/Subieedere N Fen Circaits Z? (1 to 200 Am s 0t0 30 qm s 0 to 30 Am s Above 200 qmps 31 to 700 Amps p 31 to 100 An s Swimming Pool Above 700-Am s A6ove 100_Am s Trensiormers hrigation Booms Pertia6'Other Fee Signs Speciallnspec[ion r/Z/? flemarks J224 $/•N TOTAL `G7 I, the ElecITFCSf ?OSDacbq hereby cerlily thet ihe above insDection hes Dae. ? CITY OF EAGAN N2 9 g 105 • 3830 Pilot Knob Road, P.O. Box 27-199, Eagan, MN 55121 B G PHONE:454-8100 ' ? I ? ?-1 2 UILDIN PERMIT Receipt # -- To be used for BASEMENT FINISH Est. Value $1, 500 Date Mt1Y 22 , 19 91 Site Address 3222 EVERGREEN DR Lot 57 Block 1 SeG5uhCOACHMAN HIGHLAND OFFICE USE ONLY P8fC8l NO. Occupancy - FEES Zoning _ w Name STEVEN K SWENSEN (ACiual) Const Bldg. Permi[ 35.00 3 Address 3222 EVERGREEN DR (Ailowable) _ _ 00 1 0 Surcharge . City EAGAN Phone 454-3987 M of Stories _ Plan Review Length _ o Name SAME Depih SAq Cit 8 - y 0 4 Address S.F. 7ma1 - , SAC, MCWCC ? City PhOY1B S.F. Footprints - Water Conn On Sile Sewage _ r Fw Name OnSileWell W t M t ?? AddreSS MWCCSystem - - er er a a ?z aW City Phone cuywater - AccL Deposit PRV Required - S/YY Permil 1 hereby acknowlege that 1 pve read this application and s[ate that the Boosler Pump - S/W Surcharge information is correct and ?ree lo c all applicable State of p Minnesola Statutes and City ¢ gan . &d c Trea7men t PI Signature o1 Pefmit60 APPflOVALS Road Unit A Buildinq Permit is issued to : STEVEN K SWENSEN Planner - park Ded. on the ezpress condition that all work shall be done in accordance with all Council 50 applicable State ol Minnesota StaWtes and C ity of Eagan Ordinances. Bmg. Oft _ Copies . BuildingOilicial ?? y ? u r???ull l Variance - TO7AL 36.50 • CASH RECEIPT • CITY OF EAGAN _ 3795 PILOT KNOB ROAD EAGAN, MINNESOTA 55122 Itf DATE AMO Grv co ' pM ?r ?o S - -------------- oG -7o ?. U . ?y > Thank You ??- . '3"?3 f?_ 61978 B" ? ` White-Payers Copy Yeilow-Posting CoPY Pink-File Copy ? _ 3830 Pllol Knob R di P.O. Box 2G-n1 9, Eagan, MN 55121 N;' ? 840 PHONE: 454-8100 BUILDING PERMIT Receiptx ?7 Tobeusedtor 1 OF 6 PLEX Est.Value $62•000 Date APRIL 22 19 86 SiteAddress 3222 EVERGREEN DR Erect E7 Occupancy R3 Lot 57 Block 1 Sec/Sub. COACHMAN HIGHLAIBDSdel ? Zoning R4 ParCel No Repair O Type of Const. IT . Addition ? No. Stories 2 a BRUTGER COMPANIES INC nnove ? Lengtn-?7- ? Name SUNWOOD DR., P.O. BO Demolish ? Depih -?? o Addres Int.lmpr. ? Sq.Ft City ST CLORne 612/252 -6262 Install ? i I Name SAME ? a I Address '' CiN Phone FwlName BLUMENTALS ARCHITECTS INC a Address 6100 SUMMIT DR NO a W Cirv BROOKLY?aQTR 571-5550 Ihere6yacknowledgethatlhaveread pplicatii information is correct and agree to ly with all Minnesota Statutes and rtlinanc Signature of Permitte A Building Permit is issued to: t3KUTuk aIP work shall 6e done in accordance with all Builtling OHicial INC Assessment water & Sew. Police Fire Eng. Planner @ouncil BIdg.Off.4/22/86 Permit " '-" "" 31.00 Surcharge Plan Review 159.50 SAC 575.00 Water Conn. 500.00 Water Meter 63 . 50 Road Unit 290.00 Tr. PI. 156 . 00 Copies--,-.0 0 Total on the express canditian that City o(,Eagan Ordinances. CITY OF EAGAN N 0 117 7 9 3830 Pilot Knob Road, P.O. Box 21-1 99, Eagan, MN 55121 PHONE: 454-8100 BUILDING*PERMIT Receiptp ? Tobeusedfor FOUNDATION EstValue Date APRIL 14 86 19 3216-3226 EVERGREEN DR Site Address Erect ? Occupancy Lot 54-S9ock 1 Sec/Sub. COACHMAN HIGHL ?NVigel ? 2oning Parcel No Repair ? Type of Const . Addition ? Na. Stories ? BRUTGER COMPANIES Neme Move ? Length i 1 SUNWOOD DR., BOX 399 7 ; Addre Demolish 0 Depth ss ° Ci?, ST CLOt?j 252-6262 Int.lmpr. ? ? S FL 9. one Ins?ll o Name SAME Approvals Feee a $15.00 Address $ Assessment Permit m ? Ciry Phone Water R Sew. Surcharge UQ Police Plan Review w W Name P i Fire SAC za Address Eng. Water Conn. `a 6 Ciry Phone Planner Water Meter Council Road Unit Iherebyacknowledgethatlhaver ac ' applicaionan?tat atthe Bldg.Off. 4 /14/86 Tr.PI. information is correct and agre mply with 11 app c e te of Minnesota Statutes and Ci n Ordin c APC Parks Var. Date Copies? SignatureofPerminee Total '?17?OO BRUTGER COMPANIES A BuildingPermit is issued to: Ci? on the express condition that all.work shall be done in accordance with all applicable Stat f Minn ota 5 a 'ty of Eagan Ordinances. Building Otticial CITY OF EAGAN Remarks bI V•g I 1 f L I Addition '`+OAf+MAN HIQHLANDS Lot 57 Blk 1 Parcel 10-18075-570-01 owner streec 3222 EYERGREEN BRIYE State EAGAN MN 55121 Improvement Date Amount Annual Years Payment Receipt Date STREETSURF. l ]S Paid und r rcal 10 2750 -DiQ-03 STREET RESTaR. 1974 if if GRADING 1007 1986 354.14 35.41 10 S, c - /00-/3 l0 - - S SAN SEW TRUNK 1968 , pa;d und cei 10 2750 DiQ-01 SEWER LATERAL 1984 ?t eo rt * WATERMAIN ? 1972 Paid und r STCel 10 2750 -010-03 WATER LATERAL 1975 to to • WATER AREA 1972 of it WATER LATEM 1975 STORM SEW TRK 1975 STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER COMN. BUILDING PER. SAC PARK )F EAGAN Owrer. /1ddress ilot Knob Road -------- ?-----7389 ----^- ok 21199 PERMIT N4.: MN 551 ??, D^TE: `? " ? -p et No. of Units: :rut€;er „ornpan, : ' 1772 S?? ???. .verorepn _ r ve R ,oac man fi o an ; Plumber: Metar No.: 3 ? 7 ? 5i2Q; '? ac x Reader No.: 0 / Al / 1 M.w ft eanatp wh6 CITY OF EAGAN WATER SERVICE PERMIT 3''30:'°'bt Knob Rosd P. O. 6ox 21199 F'ERMIT NO.: _., Eagan, MN 55121? DATE: u r,-?? e:Y No. of Units: Brutfier .ompany .,...,o.: Address: - -?; rvergreen Jr ,oac n iQ? a? r> Site Address: f:enz-?.va?? P1uxr+ber. Meter No.: I„p , Size: </99,42 c M , _ , , " "Pririi«• [C[v??+?0?•? . n i ..... to Owlvrr wuh the c*K4" I Rbghc" J- l. . .,., k.? Misc. Gw?qes: ? p OdIM Total: .. ?? ?`' Dote Pold: Dore of I??sp•. I^sp.: J -7'4r&z r?Pr Compa'n'.r Address: 3222 Sv?rzr;,PT, ,•?i?F. ?_,•i? ?1 (;asLh:nan .i; k:.`?' ? • E? ? ? I ym f0 a0111i* Wilobthe City Of g040i Gd1?'f4Gtld1 QIOrge: OrdiMwas. Acoount Deposit: Plmlit Fel: SUfCh0/'Q0: - - ;; . } _--? - By Misc. Charflss: Date of Irrsp.: Total: CITY OF EAGAN SEWER SERVKE PERMIT 3830 Pilot Knob Road p??T NO.: P. O. Sox 21199 . Eagan, MN 55121 DATE: - Zoninp: F3 No. of Units: Own0r: ti,-uig@X` Address: Site AMrass: Plumber: I ym t0 oomwly M!bb dw C7 of 5000A "Nwoa. By Dote of Insp.: CAf1f10CtiOT1 Q1CIg0: 4 7 5 • W eC M,couM Deposit: Permit Foe: Surohorne: mIfC. a10fQei: - Totoi: DoN Paid: x• ;. CITY OF EAGAN SEWER SERVICE PERMIT ' 3830 Pilot iCnob Road p???T NO.: ' P. O. Box 21199 _ Eagan, MN 55721 DATE: Zanino: - ='w No. of Unlts: ?: .- PLUMBING PERMIT CITY OF EAGAN 3830 PILOT KNOB ROAQ, EAGAN, MN 55122 Site Address Lot-? f Z m Name /j m Address ? ciry ? Name 3 Addre: 0 C'ty - PERMIT q ?Z RECEIPT # 7 7 // ? OATE: 51111 7 f ! - FEES COMM/IND FEE - 195 OF CONTRACT FEE APT. BLDGS - COMM RATE APPLIES TOWNHOUSE & CONDO - RES, RATE APPLIES MINIMUM - RESIDENTIAL FEE - $12.d0 MINIMUM - COMMlIND FEE - $20.00 STATE SURCHARGE PER PERMIT - .50 (ADD $.50 S/C IF PERMIT PRICE GOES BEYOND $1,000.00) FOR: CITY OF EAGAN BLDG. TYPE WORK DESCRIPTION Res. New Mult. Add-on Comm. Repair Other RES. PLBG. ONLY - COMPLETE THE FOILOWING: NO. FIXTURES TOTAL Water Closet - $3.00 $ Bath Tubs - $3.00 Lavatory - $3.00 Shower - $3.00 Kitchen Sink - $3.00 Urinal/Bidet - $3.00 Laundry Tray - $3.00 Floor Drains - $1.50 Water Heater - $1.50 Whfrlpool - $3.00 Gas Piping Outlets - $1.50 (MINIMUM - i PER PERMIn % Softener - $5.00 `5- ? well - $10.00 Private disp. - $10.00 Rough Openings - $1.50 FEE 1. STATE S/C: .? GRAND TOTAL: . • PE14MIT #0ci- CITY OF EAGAN FEE PLUMBING PERMIT ?- RECEIPT # 454-8100 S/C ? MINIMUM RHSIDENTIAL FEE - $10.00 + $.50 TOTAL DATE MINIMUM COMMERCIAL FEE - $20.00 + $.50 1. Bldg. Type: Res ? Comm Inst 2. New Add Alter 3. Total Bid Price ?,? ??- ? 4. Job Address Lot- Block 6. Contractor ?--?V-? (Name) 7. Contractor Phone # NO. FIXTURES ? Water Closet - $3.00 ?Bath Tubs - $3.00 =Lavatory - $3.00 Shower - $3.00 __LKitchen SinkJ 3.ap l IrinalJRirioA _ t-q tlh Signed: Approved NO. FIXTURES _Laundry Tray - $3.00 Floor Drains - $1.50 =Water Heater - $1.50 Whirlpool - $3.00 =Gas Piping Outlets - $1.50 -Softener - $5.00 Repair NO. FIXTURES -Well - $10.00 Private Disp Syst - $10.00 3Rough Openings w/o Fixtures - $1.50 (D'E PLUS =.50 STATE SURCHARGE FOR EACH S1,000 OF FEE. 1- for Inspections: Date Rough Insp. Date Final Insp. PEfRMIT # ? S CITY OF EAGAN FEE ?•? MECHANICAL PERMIT RECEIPT # 454-8100 S/G MINIMUM RESIDENTIAL FEE - $10.00 +;.50 TOTAL DATE MINIMUM COMMERCIAL FEE - $20.00 + $.50 1. Bidg. Type: Res Comm Inst 2. New ?' Add Alter_, Repair -9 ..?J "^? ' 2y2 ti?_c:.r?c??2?-z"'Y `?r,+L. 3. Totsl Bid Price ?--? 4. Job Address " ? Lot7 Block SeC :%??? .'w? ?`?? .`.'L.a.,,? 5. Owne?-.t-{?'? '-:3 • 6. Contractor r (Name) _ ? (Sfreet) (City) (Zip) 7. Contractor Phone # t z -- RESIDENTIAL HEATING - 01-100,000 BTU's -$24.00. Each additional 50,000 BTU's or haction -$6.00 RESIDENTIAL COOLING - 01-24,000 BTU's -$12.00. Each additional 6,000 BTU's or fraction -$6.00 MODjFICATIONS/ALTERATIONS -$10.00 minimum fee HEATING VENTILATING HOT WATER STEAM AIR COND. eIR PIPING PROCESSED PIPING AIR HAND. EQUIP. RtFRIG. RES. GAS PIPING OUTLETS - $1.50 TANKS: L.P. UNdERGROUND OTHER COMM./IND. RATE - 1% OF TOTAL B PRICE PLUS $.50 STATE SURCHARQE FOR EACH $1,900 OF FEE. C ? Signed: for ' -^? ?_--- ? ??,c ? •.i?•---_ Approved Inspections: Date Rough Insp. Date Finai Insp. I ' 3830 Pilot Knob R d! P.O. Box?ZG-A1 9, Eagan, MN 55121 11779 PHONE: 454-8100 ? BUILDING PERMIT Receipt # FOUiJDN'1'I ON r-.. nfl}e A?PR iL 14 ,o 66 Parcel No. Repair Addition W Name BtIUTGER COI?lP1,NIES DeMove molish 3 Address 1 SUNWQOD DR., SOX 399 a Int Impr. City ST CLOPP6ne 252-6262 Instau Z o Name 5AME ? ? Address City Phone Address Phone ? I hereby acknowledge that I have repd ?plication information is correct and agree t6 ' mply with all al Minnesota Statutes and Ciry o6fa " n Ordinar?Ces. ` ,?. Signature of Permittee BRUTGER C A Building Permit is issued to: all work shall be done in accordance with all applicable Occupancy Zonina Type of Const No. Stories Length Depth Sq. Ft Assessment _ Water & Sew. Police Fire Planner of Bldg. of Permit ?1=' • ?'? Surcharge Plan Review SAC Water Conn. Water Meter Road Unit Tr. PI. Parks Copie . [he express condition that . PwmR No. PNmN Holdw Dsb TMephone N lumWny [ . H.V,A.C. iecbic Ir3l ??g ?? softef"W InspeeHon Dsts Insp. Commenh Footlnys I Foodnys ii ' Foundatbn FrarMnp RooHnQ Rouyh Plbp. Rouph Htp. IrouL Fireplaee Ffnsl MIQ. Finel Plby. &dy. Finsl Cert. Occ. Dock Fty. Deck Frmp. Wdl Pr. Dbp. e _. , . . . . . ,. M. . «, j', .;.S•,r,. } ? .. .. . . , , .. --? CITY OF EAGAN { Y' ? ? ? ? J ?3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 - f BUILDINCPERMIT PHONE: 454-8100 Receipt # ' - To be used for BA3BMM F11113$ Est. Value. $I , S00 Date = ZZ , 19 g? Pdf W NO. Occupancy - FEE$ ¢ Name ? 1L BTiE!lSEN Z?i? (Actual) Const 3500 Permit • Bldg „l - . ; ° Address 3222 Djt (Albwable) - Surcnarge 1-QO City RAGN Phone 454-3987 # of Stories _ Plan Review Lenglh _ p Name SAMW Deplh SAG Cit = - y ? (OJ Ot Addf@SS ? S.F. Total - SAC MCWCC City Phone S.F. Footprints - , t W C On Site Sewage er onn a WU¢ w Name on sice weli - Water Meter x? Address • Mwcc sy5teFn - < W City Phone ciry water , - Aect. oeposit PRV Required _ S/W Permit I hereby acknowlege that I f ve read this application and state that the Booster Pump - S/yy Surcharge in ormation is correct and lid rep to c mp with all applicable State of Minnesota Statutes and City gan d ces. t Treatment PI Signature of Permitee APPROYALS Road Unit A Building Permit is issued to: STVRp KSWMZN Planner park Ded. an ihe express condition that all work shall be done in accordance with all Council ? applicable State of Minnesota Statutes and City ot Eagan Ordinances. g?, pH. _ ?P?s 0 Building Otfici8l Variance - TOTAL ?? ? PermN No. ' Permft Holder Date Telephone # WATER SEWER PLuMeiNc QQ .r1.nr?r? 00V 1-15 f•38% H.VAC. eLecrRic Inspection Date Insp. Comments Footings I Foundation w A' Framing Roofing Rough Pibg. IAXI fiough Htg. Z o Isul. ?rs C f G?' i?- c Y i ? Fireplace Final Htg. ?' - Orstat Test /- Final Plbg. ? Plbg. Inspector - Notify Plumber Const. Meter EngrJPlan Bldg. Final ` Dedc Ftg. Dedc Fnal 2 S ? /Ya Wel1 Pr. Disp- / ?111 RESIDENT / OWNER Name: e0A-C 1-4 14 -41- AIl✓1-( LADS' .T6tit 1 - Address / City / Zip: S AJO . J r L4 I DA- Applicant is: Owner X/ Contractor TYPE OF WORK Description of work: RE-1 Construction Cost: 7/ S ©C � Multi - Family Building: (Yes x / No ) CONTRACTOR Name: RccF an /41 /4 --N'. License #: ac l '7 / .-.3 Address: S (JA-144 ,4(* /. ' : City: ST: M-f/ i-/ L State: Zip: 5 '? Y Phone: 76 3 - S S D d c y e -+- v-s u./ it, Nro Of- . C o3 Contact: �� 2 ( � Email: h Co Owl �/ COMPLETE In the last 12 months, has Yes No If yes, THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING the City of Eagan issued a permit for a similar plan based on a master plan? date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Sewer & Water Contractor: Phone: Phone: NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the information may classified as non - public if you provide specific reasons that would permit the City to conclude that they are trade secrets. City of Eaall Tenant: 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 Applicant's Printed Name X Applicant's Signature Far fi Permit #: Permit Fee: Date Received: Staff: 2010 RESIDENTIAL BUILDING PERMIT APPLICATION Use BLUE or BLACK Ink Date: ( S Site Address: (3 ? lc:; CUEize,Reen) b R• /Lc), i (i(1 32 -19 r 39-2 1 2-24 s 8 #: CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454 -0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.Qopherstateonecall.orq I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Page 1 of 2 - - , 3a I (�, �3a1 � 3a�� �aaa, 3a�y� 3�a�, Use BLUE or BLACK Ink .------------------ � For Office Use � • j Pertnit#: ! � 1G��11/V � Clt� of ����Il � Permit Fee: � �� a S � 3830 Pilot Knob Road � Eagan MN 55122 � Date Receiverl: �'�� � i Phone:(651)675,5675 I Staff: � Fax:(651)675-5694 � � a��������� �������J 2014 RESIDENTIAL BUILDING PERMIT APPLICATION Date: !� 6 r7-C�� Si�Address: JO��� - ��� �u�X`u'�'�,�� ���� Unit#: �b°-�b��a Name: Phone: ReSitien#/ �?W11�t' ' Address/City/Zip: ��.«D- 3�.Io �U��,(��� �Q-t�� Applicant is: Owner � Contractor ' Description of work: � ���� Typ�Of Work ,,, Construction Cost:� 5 �b Multi-Family Building:(Yes�/No_� Company: l�'F' G�7.- /V• � _ �1�1G• Contact:'�'��V`�+''� C7A�TI�� � COtl�MGt�t Address: �75�� �U.i�IPV� IA(�'�_ ►V�. City: �' 1°n�����(.. state:�l� Zip: �� Phone:IO��05'b��1 Emai�: f��f�-O✓1,�. c�n.C.� �U��� I.� License#: � �1ci-t�� Lead Certificate#: If the project is exempt from Isad certification, please explain why: (see Page 3 for addi�ional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months,has the City of Eagan issued a permit for a similar plan based on a master plan? Yes ,No If yes,date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer 8�Water Corrtractor: Phone: �11U�TE:Plans atrd sapport�ng dt�cumerrts tha#you subt»it ar+e consic�►►�r�ed to+be prt16l�'c ittlr�rm��rn. Por��ns of ti►e�r+formatton may be c�assi�c�al as nort-p�btic�f you pro�icie�cifie reas�r�s�af wc�ul�`permft#he C�ty to conclude#hat`#he� are trade se�r� ` CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utiliry damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.qo�hers#ateonecali.orq 1 hereby acknowiedge that this infortnation is complete and accurate;that the viro�lc will be in confonnance with the ordinances and codes of the City of Eagan;that 1 understa�this is not a permit, but only an application for a permit, and rnrork is not to start withart a permit; that the work will be in acxordance with the approved plan in the case of work which requires a review and approval of plans. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit iasuance. �, _.. x�E�U �a�R�t �lC� x ApplicanYs rinted Name Applican s ignaturoe Page 1 of 3 Use BLUE or BLACK Ink For Office UseC ' ::' ftyofEa ,aii 1 3830 Pilot Knob Road Eagan MN 55122 ( Date Received: Phone:(651)675-55675 buiidinainspectionstcitvofeaaan.com 117 Stat 2017 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Unit#: l i fid,- 1,'.y 1'M•ts-:i�� Name: _ -c i;N�.+<, � �,n l�Y`.� 1�. . y Phone: `i�� . ' -cies 31S"),‘,, Re •sident! Owner Address City/Zip: 3 � V.2v-a� ✓, r �t2� 1 Applicant is: Owner 'X Contractor Type of Work Description of work i4-e rm v'--� -ti' Construction Cost Multi-Family Building:(Yes )4 I No ) Company: `a �, =n��#� u�3�;�, C�c, contact XrlV, Contractor Address: Z t _ `� a-- City: !a- Z1).5t-,v- State:i"r�, Zip: 5S`J 6`S Phone: t -3 'a333 Email: 5-2\Da c3 . -,.. License#: -t 3 3_11`'t Lead Certificate#: % 1 If the project is exempt from lead certification,please explain why: cl !f G -� - COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING in the last 12 months,has the City of Eagan issued a permit for a similar plan based on a master plan? Yes No If yes,date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer&Water Contractor: Phone: Fire Suppression Contractor: Phone: NOTE:Plans and supporting ckwumentsdocumentsthat you submitconsidered to hepub .lnfortnstlora Portions ofthe are informatitrade onsecret=maybeclasslfleztas°i�ub .Ifyouprovide seasonsthat;would-Permit the fltytoconclude-thatthey You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's website at www.cityofeaaan.comisubscribe, Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. CALL BEFORE YOU DIG. Call Gopher State One Call at(851)454-0002 forprotection against underground tai y damage. Cad 48 hours before you intend to dig to receive locates of undergromumci crtilities_ www_oopherstateonecal.orsi I hereby acknowledge that this informations complete and accurate;that the work will be in conformance with the ordinances and codes of the City of Eagan;that I understand this is not at permit,but only an application for a permit.and work is not to start w ut a permit;that the work will be in accordance with the approved pilar in the caserof work which requires a review and approval of plans. Applicant's Printed Name Appllcant's Signatur Page 1 of 3 .g rad, 1J j'��` �DO NOT WRITE BELOW THIS LINE /q6-0047 SUB TYPES _ Foundation _ Fireplace _ Porch(3-Season) _ Exterior Alteration(Single Family) _ Single Family _ Garage _ Porch(4-Season) _ Exterior Alteration(Multi) Multi X Deck _ Porch(Screen/Gazebo/Pergola) _ Miscellaneous 01 of_Plex _ Lower Level _ Pool _ Accessory Building WORK TYPES New _ Interior Improvement _ Siding _ Demolish Building* Addition _ Move Building _ Reroof _ Demolish Interior Alteration _ Fire Repair _ Windows _ Demolish Foundation Replace Repair Egress Window Water Damage Retaining Wall *Demolition of entire building—give PCA handout to applicant DESCRIPTION Valuation 1) { Occupancy 3 MCES System Plan Review Code Edition f , s fi SAC Units (25%•2( 100% ) Zoning I City Water CensuslCode Stories Booster Pump #of Units Square Feet PRV #of Buildings Length Fire Suppression Required Type of Construction7-6—, Width REQUIRED INSPECTIONS Footings (New Building) Meter Size: X" Footings(Deck) Final/C.O. Required `' Footings (Addition) X Final/No C.O. Required Foundation Foundation Before Backfill �/ HVAC_Gas Service Test Gas Line Air Test Roof: _Ice&Water _Final Pool:_Footings _Air/Gas Tests _Final Framing 30 Minutes 1 Hour Drain Tile Fireplace: _Rough In _Air Test Final Siding:_Stucco Lath _Stone Lath _Brick_EFIS Insulation Windows Sheathing Retaining Wall:_Footings_Backfill_Final Sheetrock Radon Control Fire Walls Fire Suppression:_Rough In_Final Braced Walls Erosion Control Shower Pan Other: Reviewed By: , Building Inspector RESIDENTIAL FEES Base Fee A i a r in �/�, . Surcharge r fi L, Plan Review MCES SAC City SAC Utility Connection Charge 01 S&W Permit&SurchargeThi g Treatment Plant (fit C- Copies TOTAL Page 2 of 3 PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA166168 Date Issued:12/17/2020 Permit Category:ePermit Site Address: 3222 Evergreen Dr Lot:57 Block: 01 Addition: Coachman Highlands PID:10-18075-01-570 Use: Description: Sub Type:Residential Work Type:Replace Description:Standard Water Heater Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087 Surcharge-Fixed $1.00 9001.2195 $60.00 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Xuan Lin 3222 Evergreen Dr Eagan MN 55121 (651) 808-0605 Champion Plumbing 3670 Dodd Rd., #100 Eagan MN 55123 (651) 365-1340 Applicant/Permitee: Signature Issued By: Signature