3230 Evergreen Dr<* -? 2% b S 2006 RESIDENTIAL BUILDING rERAIIT arrLicaTioN
#3"; r.zs
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New ConsWCtion Reouirements
3 regislered site surveys showing sq. ft. of l04 sq. tC of house; and all roofed areas
(20%maximum lot coverage allowed)
2 copies of plan showing beam 8 window sizes; poured found design, etc.
1 set of Energy Calculations
3 copies of Tree Preservation Plan if bt platted after 711193
Rim Joist Detail Options selection sheet (6uildings wdh 3 or less unifs)
Minnegasco mechanipl venGlaUOn form
RemodeVReoair Reauirements Ofifce Usg.Onlv
2 copies of plan showing (ootings, beams, jasts Cert of Survey, ReaJ Y . N
7 set of Eneagy Calculatbns for heated additions Tree Pres Plan Recd Y _ N,
t sde survey for additions & decks Tree Pres:Reqwred `Y N
Addifion - indicafa if on-s'rte sep6c sysfem On-site Septic System -_Y_-N
Date ?! Construction Cost
Site Address 3 Z Z g l UnitlSte #
?- 323b 3 3z '?z3`f VZ36 3a39
Description of Work V4Ci(.e :y1Q n ? W 1 n L?9v7S
Multi-Family Bldg ? Y _ N Fireplace(s) _ 0 _ 1 _ 2
PropertyOwner l o,,k. N mA ,) 149 040W I vwn N Omt S Telephone #( )
?(1
Contractor Tit YkA r$_,?q r) d ?_A 'Kf_1()6
Address 'j3Sl biekwoock [y N It 130 City 61eovC
State /? IJ Zip `7's3L6J Telephane #qo'j ) 1L?` DS?/?
COMPLE7E THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Categorv 1 Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(J submission type) Submitted Su6mitted
. Energy Envelope Calculations Submitted
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_ Y _ N If yes, dafe and address of master plan:
licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone #(
Telephone #(
Telephone # (
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of NIN
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved p1an in the case of work which requires a review and
approval of plans.
2 ?il?tTTlh?J4t? C
Applicant's Printed Name ApplicanYs Signature
PERMIT # q7q "
RECEIPT DATE:
USID£NTIAL PL1JM$IN6 PEgMIT APPLICATION
crrY oF EAsAx
3930 Pu.oT Krros Rn
EA6AA, MN 55122
651-681-4675
Please complete for. ? single family dwellings
? townhomes and condos when permits are required for each unit
? backflow preventer for irrigation system
SITEADDRESS: 3Z30 ??1?? ?R1?L
OWNERnIpME ? WNAw? NEZCNLdD ?E LEPHONE#: W?s?
-- - - _ _-- ---- ------------
--`----------- (AFEACODE)
INSTALLER NAME: IUr.(;IIIREFi SONS TELEPHONE #: 9SZ
STREET ADDRESS: 60512th Avenue 56uth (AREA CODE)
CITY:
Place a check mark next to the permit work tvoe
STATE:
ZIP:
New residential dwelling unit under construction and not owner/occupied $ 90.00
Add-on, modification or alteration to existina dweiling unit, including: $ 50.00
• abandonment of septic system
• new installation/repair/rebuild of RP2
• lawn irrigation system
• water turnaround
Nature::`work: wp1?`
Septic System, new/refurhished - $ 225.00
• includes County & Consultfng Inspector fees
• requires MPC license
State Surcharge $ .50
Total $
Reminder: Be sure to schedule inspections of alterations, i.e. water heaters, water softeners, etc.
I hereby acknowiedge lhat I have read this application, state that [he information is correct, and agree to complywith all applicable Ciryof Eagan ordinances. It
is the applicanYs responsibility to notify the property owner that the City of Ea9an assumes no liabiliry for any damages caused by the Cily during its normal
operational and maintenance activities to [he facilitles constructed under [his permit withi Cily prop /rightrof-wayJeasement.
SIGN T E OF IMITTEE
Updated 1101
ClTY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(651) 681-4675
SITE ADDRESS:
PERMIT
PERMITTYPE: au.r.LDitvc
Permit Number: 034067
Date Issued: 11117 / q8
3228 EVERGFYEL-N OR
LOTe 68 f3l.pCK, 1
CC1ACSiA1AN HIGHLAN05
P.'i.IV.e 10-18075-500-01
DESCRIPTION:
P L ex
muLrz? (M.zsc,)
REPAtiR
434 ALT. RESIDEN7IAL
i ?
. ? RER00F1 6
BGilding-A_ermir Typs
t3uildinq W6's4; Type
,`Census Cnde -
?
i -
:.
?. .?- --
REMARKS:
ThCLUC1ES
FEE SUMMARY:
3Z'3b. 3232 . 3234 , 3:'36. FiMti 3.^38.
VAL.UAT;Ct)N
Base Fee
Surchar-ge
Total Fee
$137 .?5
.._.._.._?.... _. _w....._..? ? .:_? B.
$191.25
$8,000
CONTRACTOR: - a p p 1 i c a n t- OWNER: '
BEISSEL WINDOW & SIDING 24616536 CONCHMRN HIGHLAi+1175 AS50C.
3;e'13 EVERf,REEIV pR 3228 EVERGftEEN DR
E?AGRN MN 55121 EAGAN MN 55122
(612) 0.51--6835
R
C hereby acknowledge that S Nave read thi5 a'Pplicatican and 5tote that the
infarmation is correct and agree to comply with ali appli.cable Sfate cs€ Mn.
Statutes and City of Eaqan Qrtlinance5...
?
APPLICANTlPERMITEE SIGNATURE
I D 8Y: SIGNATUR
I
foll ' t btain
1998 BUILDING PERMIT APPLICATION (CObIMERCIAL)
CITY OF EAGAN
681-4675
.,,:.
ubmit owing o o ,,.. ....•, ,..
Foundation Only VV -•,••.•
New Construction
. Interior Improvement
structural plans (2 sets) architectural plans (2 sets) architectural plans (2 sets)
civil plans (2 sets) structural plans (2 sets) code analysis
t (1)
(7 set)
code analysis (1) civil plans (2 sets) specs
projec
soils report - (1)
ecs (1)
t landscaping plans
code analysis (2 sets)
(1) " Key Plan
energy calculations
(1) not always "
projec
sp
Special Inspections & Testing Schedule " soils report (1) Electric Power & Lighting Form (t) notapxays "
SAC detertnination letter from MCMfS - SAC determination letter from MCM1S - SAC detertnination letter from MCNVS -
call 602•1000 call 602-1000 call 602-1000
Special Inspections & Testing Schedule (1) "
project specs (1)
energy calculations (1)
Electric Power & Lightin Form (1) " S
Contact 8uiltling Inspecnons tor sampie
Food & Beverage or Lodging facilities: Plan must be submitted to Minnesota Department of Health. Call 215-0700 for details.
DATE: ? ?- ? b"9e!?? WORK TYPE: _ NEW ? REMODEL
DESCRIPTION OF WORK:
CONSTRUCTION COST:
51TE ADDRESS:
SUITE #:
3a7)6, 341 3a?4, 3a=a?-
LOT (nC) BLOCKSUBD. G.U..AA P.I.D. #
?
PROPERTY Last
OWNER
Street
City
Fust
State:
Zip:
Company: Phone #: y-fEL UR 3S _
CONTRACTO
R Street Address: lrcense #
1 \ ? _ ?City S4ate: ? ?-J - ZiP: ??-
ARCHITECT/
ENGINEER
Street
Cily
Sewer & water licensed plumber (only if installing sewer & water):
Phone #: -----
_ Registration ti: _
S4i[e: -------- Lip:
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.
TENANT NAME:
Phone #:
Signature of Applicant:
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation
? 18 Comm./Ind.
WORK TYPE
? 31 New
? 32 Addition
GENERAL INFORMATION
Const. (Actual) _
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
? 19 Comm./lnd. Misc.
? 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.
Planning Building
Engineering
? 21 Miscellaneous
? 35 Tenant Finish
? 37 Demolition
MCN11S System
City Water
Fire Sprinklered
Census Code
SAC Code
Census Bldg.
Census Unit
Variance
Permit Fee ?
Surcharge
Plan Review
MC/WS SAC
City SAC
Water Conn.
S/W Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Water Qual.
Other
Copies
Total:
% SAC
SAC Units
Meter Size
Valuation: $
9 ?=: -- t
'ib B2 U52c1 FOL' 1 of 6 Plex
CITY OF EAGAN , Include 2 sets o£ plans,
1 site plan w/elevations &
BUILDING PERMIT APPLICATION 1 set of enerqy calculations.
z BtRk, 3`.7aoe Valuation $3rB00 Date July 13, 1983
Sit2 Pddre5s 3230 Evergreen Drive
Lot 61 BloCk 1 SeC./SUb. Coachman
ParCel #: Hiqhlands
OWrier: Brutqer Companies, Inc.
AddYess: One Sunwood Drive, P.O. Box 399
Qty/Zip Code: st. Cloud, MN 56302
Phone #: (612) 252-6262
ContYaCtOr: Brutger Companies, Inc.
PddZ'255: One Sunwood Drive, P.O. Box 399
City/Zip Code: St. Cloud, MN 56302
Phone #: (612) 252-6262
Arch./II1q.: Slumentals Architecture, Inc.
A[idTeSS: 6100 Summit Drive North
Ciiy/Zip COd2: Brooklyn Center, MN 55430
Phorie #: (612) 571-5550
OFFICE USE ONLY
? ?
Erect Occupancy T/
3 T
Alter Zoning
Repair Fire Zone
Enlarge _ Type of Const.
A'bve # Stories Z
Deirolish Front ft.
Grade Depth ft.
_ APPROVAT.S FEES
AssessRnents Pexmit y yy t00
?+7ater/Se,aer Surcharge j_x
Police Plan Check / S
Fire SAC ?
EESig. Water Conn.
? o
Planner Water Meter ,5o
'
Council Road Unit y,,-o
Bldg. Off.
APC
=AL -+ 17q R "550
Bldg. A-4
BUILDING PERMIT
N° 8328
Receipt #
T. 6a uwd for 1 of 6 PLEX Est. Volue $53, 000 pote Aueust 1 _, 1 983
Site Addrcss 3230 Everereen Drive Eracr ? Occupancy R-3
Lot 61 Block 1 Sec/Sub. Coachman HiQhlands Alre. ? Zonin9 R-3
Purcel # Repair ? Pire Zone NA
E
l T
f C V
. n
arge ? ype o
onst.
u
w Name BrutQer Companies, Inc. Move ? # Srories 2
=
9 AddrenOne Sunwoad Dr., P.O. Box 399 Demolish ? Length_
C:ln„. 7 M ,.__ 919_A'J/,9 Grade rl Depth Sa. Ft.-
o Name
uu Addrea hssessment
~ Ci Phone Water $ Sew.
?
? Police
w Nome
F
Fira
Z
Address Enp.
Ci Phone Planner ,
Council
I hereby acknowledge that I hove read this appliwtion ond stofe ihat gldg. Off.
the inlormation is wrre[t nnd ogree to tomply with all ppplico6le
$fote of Minnewto Stotutes ond Cify of Eagon Ordinonces. ApC
Buildinq Officiol CITY OF EAGAN
Signoture of Permittee
Brutger
A Building Permit is issued fo:
oll work shall be done in accordance with oll S
L
7795 Pilot Knob Raad Eagan, MN 55122
PHONE: 454-8100
Inc.
Feea
Permit 47L.VU
Surchorge 26.50
Plon check 146.00
SAC 525.00
Woter Conn. 450.00
Water Meter 60.00
Road Unit 250.00
To„i $1749 _ 5(l
_ on the expreu condltion thni
and Ciry of Eapon Ordinances.
CITY OF EAGAN
3830 Pilot Knob Road
P. O. Box 21 199
Eegan, MN 55121
Zontnp:
WATER SERVICE PERMIT
PEwNIT NO.: 4963
oATE: 8-3-83
No. of Unlts:
pwn.r; BrLtger Cn
/lddrosx
ite /?ddrcss' z t3 VBTgreel? ??•eu
?r: Hayes contractors
h? No,. 3 3 7/ 4 G •5 D Connection Choroe: 450.00 pd
size: `t Accounr Deposit:
JReoder No: :-2 3 Pennit Fee: .. 10.00 pd
IevrM M amPly MrMi e1N Ciep of Eagen Surchorye: .50 pd
Mix, q,arges; 60_00 nd meter
Totnl:
gy Dot. Paid:
Dute of I nsp.: Insp.:
CITY OF EAGAN
3830 Pilot Knob Road
P. O. Box 21 199
Eagan, MN 55127
Zoninp:
SEVVER SERVICE PERMIT
PERMIT NO.: 6 0 I?19
DATE:
No. of Units:
Owner; F?Tiltil6 C4 -
Address:
Site Addi
Plumber:
Misc. CFaryea:
CITY OF EAGAN WATER SERVICE PERMR
3830 Pilot Knvb Road 4964
P. O. Box 21199 PERMIT NO.:
Eagan, MN 55121 0^TE: 8-3-83
Zontny: No. af Units:
owner; Brutger o '
Addross:
Site Addross: -3230 Ever_reen ?r
Plumber: Hayes Contractors
Mater No.: -33??
Size: =Vg "
Rq6der No.: ..f a A
a.? of i ?.:
con?cri«, cr,ar?: _aso_nn ?d
Account Deposit:
Permit Fee: 10.00 pd
Surcharge: .50 pd
Miac. Chor9es: 60-00 bd meter
Totol:
Date Paid:
Insp.:
CITY OF EAGAN SEWER SERVICE PFt
T
38.30 Pilot Knob Road ,
P. O. Box 21199 PERMIT NO.:
Eagan, MN 55121 D/?TE:
Zoninp: No. of Units:
Ownsr: - :irutkex ?,o
Address:
Stte Add
Plumber.
I pew to oeMyl?r wi1i? Nw Cihr of loso• Connsctton Chorpe: 425. (1,?
Of?AIMAON. Acoount Deposit:
Pem+it Fes:
Surchorpe:
By Misc. Cl,orq,es:
Dote of Insp.: Total:
I nsp.: DoM Pold: -
ayre? to wn?pir whl? th? Citr oi E?yew
Ordineeu?.
I pm M eonoy wkb MM Ciey of Eepr Conneetion Chorge: 425.00 ?-d
Ordinonea. Account Deposit:
Pem?it Fee: 1?. OC
Surcharpe:
INSPECTIDN RECORD?
? CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
I (651) 681-4675
SITE ADDRESS:' APPLICANT:
'i P?,}; 1 f- td t?F• ?
PERMIT SUBTYPE: TYPE OF WORK:
It! 1'R 1 i<
fi F k flnf / i'• N1-t X
INSPECTION D• • D•
-1
?
??
Receipt PWMBING PERMIT Permit Na
CITY OF EAGAN
Fee
Fill in numbered spaces S/C Type or Print legibty ?- '
Tot.
1. Date 2. Installation Cost
J-)r/. < L,C.c Ol(?)OW
3. Job Address),-;)J? (7 c ?`?(? r r6Lott?, I Bik. j_ Tract
4. Owner LA AL-r C?'
5. Contractor, ?-L? t)?',a., ;`j Phone
6. Address
7. City State ,a21.z'A",., Zip
8. Building Type: Residential ? Commercial ? Institutional O
9. Work Description: New O Add ? Alter ? Repair ?
1 10. Describe
1 11.
No,
f Fixtures
Water Closet No. Fixtures
Cesspool/Drainfield
? Bath tubs Septic Tank
/ Lavatory Softner
Shower Well
/ Kitchen Sink
Urinal/Bidet Other
? Laundry Tray
? Floor Orains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed: ', I > ' -i i,
<,. for
Rough Finel
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-$100
Receipt MECHANICAL PERMIT Permit No. •
CITY OF EAGAN
Fee
FiU in numbered spaces S/C •
Type or Print legibly Tot.
. - ?
1. Date 2. Installation Cost /
3. Job Address F' LotBlk. ? Tract
4. Owner - I L ` ? 1LE ?
5. Contractor Phone
6, Address " ?- 7. Clty ? - I"t State , Zjp
8. Building Type: ResidentialIZ Commercial ? Institutional ?
9. Work Description: New ? Add ? Alter 11 Repair ?
I 10. Describe Fuel Type
,-
I 11.
No.
? Epuioment 9TU - M. Ea.
Forced Air ' - •- - No. Equipment CFM
Ai
H
dli
Mfg. r
an
ng:
Boilers
Mfg, Mech. Exhaust
Unit Heater
? Mfg,
Air Cond. Other
Mfg.
l
Gas, Piping Outlets
12. I herebY certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed : for
R augh F Inal
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454$700
I •, . CITY OF EAGAN
Rid? . A - 4 3795 rilot Knob Rood EeOan, MN 55122
• PHONEs 4644100
. BUILDING PERMIT Receipt #
To be wed for 1 of 6 PLL:X Est. Value ?53,000 Date Auguet 1 1983
Site AMreu 3230 vergreen Dr ve Erect
?Q R-3
Occupancy
Lot 61 Blotk 1 Sec/Sub. CosChman Highlande Alter
? _
Zoning
N
parcel -/ 8 D 7 S - dl Co/O° 0 f Repair ? Fire 2one i
E
l T
f C
rutger n
orye ?
ompan es, nc. onst.
ype o
ae Name
Move C]
# 5tories
One Sunwood Dr., P.O. Box 399
? Addross DemoHsh ? Length
Cl St. Cloud Phone 252-6262 Grode ? Depth Sq. Ft.
ix Nome VWLACL Approvals Fees
0
uu
Addrets
/hssessmenf
Permit
Woter E? Sew. L, 0
Surchorge
~ Cit p?ne ???
Police Plon check
-
? N ??
W ame Firo SAC
_? /W
dress Enp. Woter Conn. 450.00
i W G Phone Plcnner Woter Meter ?
Countfl Rood Unit
I hereby ocknowledge tlwt I hove read this opplication and stote that gldfl. Off.
fhe intormotion is correct und agree to comply with oll appliceble ^? .r?Q? T7 3 0
5tate of Minnesota Stotutes and City of Eo9en Ordinonces.
Sipnature of Permittee
BruEgei. . , C.
A Buildirp Permit is issued to: on the express conditbn tFxii
all work shall be done in atco?donce with all applicable. Stote.o.f MinnesbTa-5tatutes and Cify of Eayan Ordinonces.
Buildirg OffiNal
P??mit No. Permit HoltMr Mist. Permit No. Holdar
Plumbing
r
H.V.A.C. I? D e? ?,l Y??4- ?L'? ?
Well
Water
Diap.
Sswer
ENetric 1 S ?
InWection Date Intp. Other
Footinqs
Foundetion
Fnminp
Rouph Plbq.
l
Rough HVA
Inwlatian ?. ?
Finel Plbg. - ?
Final HVAC 17
Final
Water Deuribe Loeatfon: .
MWII
Sewer '
Pr. Ditp.
CITY OF EAGAN Remarks
Addition • COJ1C}MAN MICiHI.AND.p! Lot 61 Bik 1 Parcel 10-18075-610-01
oWnef Street 3230 EVERGREEN DRIVE State F.AGAN MN 55121
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. 27 1975 Paid und r arc01 10 2750 -010-03
STREET RESTOR. 1974 11tf It
GRADING 1007 1986 354.14 35.41 10 ,? C-1481 U-/ -
SAN SEW TRUNK 440 1968 Paid und r parcel 10 275 -010-03
SEWER LATERAL 1984 t? ot ir
# WATERMAIN '? 1972 Paid und r rcel 10 Z750 -010-03
WATER LATERAL 2 1975
• WATER AREA 1972 t ?• n i
MATER I.ATB1tAL 1975
STORM SEW TRK 1975 ?? 1t 1t
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 450,00
BUILDING PER.
SAC
PARK
RESIDENT / OWNER
Name: - -1-1164-4(.413 S' ? tithu 1f/ Phone:
Address / City / Zip: Sik- a F (Lt DP-
Applicant is: Owner Y Contractor
TYPE OF WORK
Description of work: RE /goo(
Construction Cost / / )®C Mufti-Family Building: (Yes x / No )
CONTRACTOR
Name: R ,41 /U - .44-/C. License #: ao l 7� l .5
Address: S 'U' ,4t t City: Sr P L
State: ,4A- Zip: S 7 Y Phone: 76 3 - D - 4 y c / c
Contact: I. 2 (Z Email: I Q -'V' +w J 0 ra o f Co nit . Cosh
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 be classified as non - public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
*' City of Evan
Date: P _ S /C)
Tenant:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
obfl) /7U
Applicant's Printed Name
2010 RESIDENTIAL BUILDING PERMIT APPLICATION
Use BLUE or BLACK Ink
For tJse ii�
Permit #: qNo - 7S
Permit Fee: '2
Date Received: 12s 10
Staff:
Site Address: 8 c • b)/1- b /AA
n - 3120.3 3P , 3234, 323 ' l 3 Suite #:
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.gopherstateonecall.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.
App icant's Signature
Page 1 of 2
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�-----------------
� For Office Use �
' j Pennit#: '��Q C11��113 I
Clt� Of ���l�Il � pertnit Fee: � ��-�� �
3830 Pilot Knob Road � ¢1!� /,, , �
Eagan MN 55122 � Date Received: d / //y �
Phone:(651)675-5675 I r� I
Fax:(651)675-5694 � Staff: _��_ �
�..��r��������������J
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
oate: �GI,I �Ul s�ndd�ss• �c��" �3`� �V���E.£►�➢ �'t v� un�t#� ��"�3�
Name: Phone:
�������ti 3aa� - 3a3� £v����l ����
Qyyn�� ' Address/City/Zip:
Applicant is: Owner �Contractor
7yp�Of W�Nc Description of work: �� IL�(�1�
1 w�
Construction Cost: � �� cX6 � Multi-Family Building: (Yes /No�
Company: �� C� • �� . l Y�C-- Contact:���'"1 ��1'���
Ca►ntractar ada�ess: J� �J ���'✓� �v�.. 1'���. c�ty: �I• I'�,lG I���C...
sc�e:�11� zp: ��37b Phone:l4��"��S"�OC3v� Email:`�;�7 1�1011 Y�,G� I'Y�'WW,i � �t.o�►
License#: � t��� J � Lead Certificate#:
If the project is exempt from lead certification, please e�lain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 morrths,has the City of Eagan issued a�rmit 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 Corrtractor: Phone:
MOTE:Ptans and suppor2�ng documenis that yau s�rdmit are cc�nsidereai to 4e pubi�ic i»fvnr+�►tion. J�br#ions+Qt'
the ir�'t�rmate+�n r»sy b�e�class+fied as no»pubiic it`yv�t provicile spec�c�+easons#ha#wauld pe�mlt the Cily to
" cc��relude that the ar�e trade s�cr�
CALL BEFORE YOU DIG. Call Gopher State One Ca11 at(651)454-0002 for protedion against underground utility damage. Call 48 hours
before you intend to dig to rec:eive locates of underground utilities. www.qopherstateonecali.ora
I hereby acknowledge that this information is complete and aax�rate;that the work will be in conformance with the ordinances and codes of the City of
Eagan;that I understand this is not a pertnit, but only an application for a permit, and work is not to start without 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 Stabe Bu'ding Code m�t be completed within 180
days of permit issuance.
X��W ����-��� X
Applicant's rinted Name Applicant's ignature
Page 1 of 3