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3236 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$_,?q r) d ?_A 'Kf_1()6 Address 'j3Sl biekwoock [y N It 130 City 61eovC State /? IJ Zip `7's3L6J Telephane #qo'j ) 1L?` DS?/? COMPLE7E THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 Categorv 1 Minnesota Rules 7672 Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet (J submission type) Submitted Su6mitted . Energy Envelope Calculations Submitted In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? _ Y _ N If yes, dafe and address of master plan: licensed Plumber Mechanical Contractor Sewer/Water Contractor Telephone #( Telephone #( Telephone # ( I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of NIN Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved p1an in the case of work which requires a review and approval of plans. 2 ?il?tTTlh?J4t? C Applicant's Printed Name ApplicanYs Signature PERMIT# RECEIPTDATE: 2002 RM1DERTLIEL f'LUM$INfi PERM1T APPLICATIOR crrY og E*sM S$SO PII.OT KAOB RD SA6i4R. MN 55188 657-6$7-4675 Please complete for: SITE ADDRESS: OWNER NAME: : -p?P ?? INSTALLER NAME: ?SGI?Ji °/ '0, STREET ADDRESS: _ /G CITY: ?w 4?/_ zd??G3 _ SEPTIC SY5TEM, new/refurbished (requires two sets of plans and MPC license) $ 100.00 includes $40.00 County fee Note: Additional consultant fees may apply • MODIFICATION/ALTERATION TO EXISTING OWELLiNG UNIT, INCLUDING: _ Adding fixtures to lower levels or room additions, excluding water soReners and water heaters. $ 50.00 _ Abandonment of septic system. _ Water tumaround - existing dwelling unit (+ 5/8" meter if needed -$118) Other: _ RPZ: new installation/repaidrebuild $ 30.00 _ lawn irrigation system Replacementladditional: water softener Ywater heater $ 15.00 State Surcharge $ .50 Total I herebyacknowledge that I have read this appiication, state thatthe information is correct, apppQQQ agree to complywith all applicable Cttyof Eagan ordinances. It is the applicanfs responsibility W notify the property owner that the City ot Eagan ass lia6ility for any damages caused by the City durjng iLs normal operational and maintenance activities to the facilities consWcted under this perm? i m?i?;oppe???o?f-,?ryAyleas?ment. ! 1 / ? Lti?l-c{?`. ?- SIGNATU OF PERMITTEE 1102 single family dwellings, townhomes and condos when permits are required for each unit, backflow preventer for irrigation system /zGvf TELEPHONE #: ?`?? 715?"" aj- ;;- (AREA CODE) TELEPHONE #: 1'?'r _ (AREA CODE) STATEA/r?/ 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: $ •?? f?? CITY OF EAGAN , Include 2 sets of plans, 1 site plan w/elevations & BUILDING PERMZT APPLICATION 1 set of energy calculations. 2. AM. /C, S.i/ OaO - Zb Be Used For 1 of 6 Plex Va1tMtieq,- 5a:5;;9? - Date July 13, 1983 Site Pddress 3236 Evergreen Drive Ipt yq BloCk 1 Sec./Sub. Coachman Parcel #: Highlands Qan2T: Brutqer Companies, Inc. Adds@SS: One Sunwood Drive, P.O. Box 399 City/Zip Code: St. Cloud, MN 56302 Phone #: (612) 252-6262 COI1tSaCtAZ': Brutqer Companies, Inc. AddY2SS: One Sunwood Drive, P.O. Box 399 City/Zip Code: St. Cloud, MN 56302 PhOn2 #: (612) 252-6262 ArCh./E11g.: Blumentals Architecture, Inc. Addre55: 6100 Summit Drive North City/Zip Code: _ Brooklyn Center, MIV 55430 Phone #: (612) 571-555n OFFICE USE ONLY EreCt ? . occupancv R3, Alter Zoning Repair Fire Zone Enlarge Type of Const. y _ Move # Stories z. Dgmlish Front £t. Grade Depth ft. APPROVALS FEES Assessments Permit ? ?Vater/Sewer Surcharqe ?? ? Police Plan Check Fire SAC ?- Fhg. Water Conn. y_ra ' Planner ?e Water Meter Council Road Unit 1 ?e Bldg. Off. APC S 217i'AL t I -7 -'( 1 Bldk, A-4 BUILDING PERMIT T. 6e wed fe, 1 Of N° 8331 Receipt # 3z4 Site Addreu 3236 Evergreen Drive Erect ?( Occupanq R-3 Lor 64 elock 1 Sec/Sub. Coachman Highlands qiter ? Zoninq R-3 Pcrcel # Repoir ? Fire Zone NA Enlarpe ? Type of Const. V te w Name Brutger Companies, Inc. Move p # Sror+es Z ; Address One Sunw ood Dr.. P.O. Bax 399 Demoiish ? Length_ a ?:_.St. Cloud o?' _ _ 252-6262 Grade n Depth $a. FI.- p Nome _ 8u llddreu r:... Nome _ Addreu I hereby ackrwwledge that I hove read this appiicotion ond state thot the informofion is wrrecf and ogree to comply with all applico6le Stofe of Minnesoto $tatufes ond City of Eagan Ordinonces. $ipnoture of Permittee isrurger ompanies, nc. A 8uilding Permit Is issued to: oll vrork sholl be done in acrordonce with oll ?oD (/i Sta ? o Mia Buildiny Official ? -? ? CITY OF EAGAN 9793 Pilaf Kno6 Road Fagan, MN 55112 vHONe: asa-eioo Assessment Permit G7G.VV Water & Sew. Surchorge 26.50 Police Plon check 146.00 Fire SAC 525.00 Enp. Water Conn. _ nn Plonner Water Merer 60.00 Council Raad Unit 250.00 Bldg Off. . APC Toeal $1749.50 _ on the express condition Ihnt ond Ciry of Eogon Ordinancea. . , ':-?_••.?:?_ . :;n. , _ • _. CITY OF EAGAN WATER SERVICE PERMIT 3830 Pilot Knob Road 4968= CITY OF EAGAN WATEit SERVICE PERMR P. O. Box 21198 PERMIT NO.: 3830 Pilot Knob Road 4967 8-3-85 Eagan, MN 55121 DwTE: P. O. Box 21199 PERMIT NO.: __ Zon{np; No. of Unin: Eagan, MN 55121 DATE: - 8383 pM,ner. Ar»traAr Ce _ Zonirp: No, of Units: Addrom Owner: _ Brutger Co ? sift /lddreas: 3238 Evergreen Dr L65 Bl Coachman Highlands AMmn: 3236 EverAreen Dr L64 B1 Coachman HiQhlands pl„R,r H?es ontractors tr /lddreu: MZe; eter No.: Account Connection Deposlt: Charfle: 450. 00 pd ?r. Hayes Contractors No.: 3 3 Z,f Connection Charye: 450. 00 $d ? ? Reader 5/D Permit Fee: 1 D_ 00 j2L_ Si=e: Account Deposit: ?1 cym hcompiy whb tM Cihr of Eeyee Surcharge: _ S(l ?]d lReader No.: / 9 .A h/D ?j_ Permit Fea: 10. 00 pd Misc. a,oroes: - 60. 00 pd meta ° I .lm ee eaaolr wiA t6. csty of E.qe. surcF,crge: .50 pd .rotal: p?Mncm Misc. Chorges: 11 60.00 pd met, By Dote Paid: i? Total: I pate lnspInap,; By Dots Paid: ?ab f In lrtp.: CITY OF EAGAN WATER SERVICE PERMIT 3830 Pilot Knob Road CITY OF EAGAN ?.I•?'? P. O. Box 21199 PERMIT NO.: 3230 Pilot Knob Road WATER SERVICE PERMR Eagan, MN 55127 D11TE: •''" `75 P. O. Box 21199 PERMIT NO.: Zonieg: No Eagan, MN 55121 DATE: . of Units: Zon 1?: No. of Units: Owner. ,3ruager Co ??, :irut?,cr lc? Addross: 3238 Evergreen Dr L?,:i Bl Coachraan '?`?'Qm: Siro I?ddress: ? lands Stte /?ddress: Sa. Evorgravn r G oac man i{?.c ?lan,'s Plumber: '??Yes Contractors 1Kater No.: Connectia+ Char9e: 4 50. QO pd Pi""''b°r 11ayes .ontractors Meter No.: Connection (horge: 456.00 n ??: Account Deposit: Reoder No.: Permit Fee: 10. UORd 51u: Account Deposlt: 1 yrN 1e ?? whh tIN Cih of [yen 5urcharge: . So pd Recdsr No.: Permit Fee: ?• 00 t?` prlliM.o.,, Misc. CFaMe:: 60. 00 gd aetar 1 t'rN te ooinolp wifh tw Ciyr of Eegoa $urchore@c • 50 pC Totnl: Or?iw?nau. Miac. CMnpes: lg 60. OG BY Date Paid: Totcl: Dote of Insp.: IBY Date Puid: ?'? Date of Insp.: Irno.: 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? f'(Ob PLUMBING PERMIT Permit No. CITY OF EAGAN Fe9 Fill in numbered spaces S/C • Type or Print legibly To?t? • S v 1. Date LJ 2. Installation Cost - 3. Job Address J?? ??`?'t' ??? Lot t_n r Blk. ? Tr ct:-I ! f,, '11 c\ h - ?J.f ]u?5 J c, 4. Owner 5. Contractor Phone I L.,, ? ' / 7 j 3 6. Address 7. City State Zip 8. Building Type: Residential ? 9. Work Description: New ? Commercial O Institutional 0 Add ? Alter ? Repair ? 10. Describe 11. No. ? Fixtures Water Closet No. Fixtures Cesspool/Drainfield ( Bath tubs Septic Tank ? Lavatory Softner Shower Well ? Kitchen Sink - Urinal/Bidet Other 7 Laundry Tray / Floor Drains Drinking Ftn. Slop Sink Gas Piping Outlets 12. I hereby certify that the above information is true and correct, and I agree to comply ith all ordinances and codes 99verning this type of work. f Signed : for ` Rough Final Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved _ CITY OF EAGAN 454-8100 PERMIT # 1017.1 MECHANICAL PERMIT RECEIPT # CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE ? PRICE: BLDG. TYPE WORK DESCRIPTION Fies. x New ? M ult Add-on Comm. Repair Other Name LL Z' FEES c Address RES. HVAC 0-100 M BTU -$24.00 p Ciry Phone ADDITIONAL 50 M BTU - 6.00 AOD-ON AIR COND. 0-24 BTU - 12.00 ADDITIONAL 6 M BTU - 6.00 TYPE OF WORK GAS OUTLETS - 1.50 EA. Forced Air M BTU COMM/IND FEE - 196 OF CONTRACT FEE Boiler M BTU MINIMUM - RESIDENTIAL FEE - 10.00 Unit Heater M BTU MINIMUM - COMM/IND FEE - 20.00 Air Cond. M BTU STATE SURCHARGE PER PERMIT - .50 (ADD $.50 S/C IF PERMIT PRICE GOES Vent CFM BEYOND $1,000.00) Gas Piping Outlgts # OtherZ,-t.k ? =t S, C / . FEE ? `/ S/C: SG SIGNATUR OF 4RMITTEE TOTAL• ? . FOR: CITY OF EAGAN Receipt MECHANICAL PERMIT Permit No. CITY OF EAGAN Fee Pill in numbered spaces S/C Type or Print /egib/y Tot 1. Date 2. Installation Cost ' 3. Job Address L-ot - ` Blk. ? Traci ` 4. Qwner 5. Contractor i 6. Address ` , ? 7. City ? State Zip - 8. Building Type: Residential Commercial ? Institutional ? 9. Work Description: New ? Add ? Alter ? Repair ? 10. DesCri be -li' Fuel Type 11 No, Equipment 8TU - M. Ea. Forced Air No. Equiament CFM Ai H dl Mfg. r an ing: 6oilers Mfg. Mech. Exhaust Unit Heater Mfg. Other Air Cond. , Mfg, j 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 Rough Final Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved _ CITY OF EAGAN 454-$100 Av?? • ? CITY OP EAGAN 3795 Pllot Knob Read Eayon, MN 55142 " PHONEs I54-8100 BUILDING 'ERMIT ReceiPt . Te bo wod for 1 of G PLEX Est, Vaiue $53,000 Date At ?¢ctgt 1 , 14 `? Siro ??ess 323E Eve rpreen Jrive Erect [ILX Occuponcy P1"? Lot ('4 elock 1 Sec/Sub. Coacizman t?ighlanda qlter ? Zoninfl P-; Porcel # 15 90 7Y ^ Ilk (o V4"0 / Repoir ? Fire Zone `dn Enlaroe D TYPe of Const. V No,e Brutger Co mpanies, Inc. _ ?ve 0 # Srories ' W j ,?rcn One Sun?,roo d Dr.. P.O. Box 399 Demolish ? Length ? r"-.St. Cloud e,.___ 252-6262 Grode Cl Depth Sq. Ft. $ Name ?`'ner ?F ?? Address o4....._ Name _ Address ( hereby ackrwwledge that I hove reod this application and stote tFat the informoFion Is torrect and agree to comply with all opplicoble Stote of Minnesota Stotutes and Gry of Eogon Ordinances. Sipnoturo of Permittee ftutper .antes, • A Building PeRnit is Issued to: oll work sholl be done in occardorxe with all opplicable State ot M1n Buildinq Offlciol Assessment Water & Sew. Police Fire Erp. Plonner Council Bldp. Off. APC Fees Permit /-7t.vu Surcharpe 26.50 Plon check 146.00 5^C 525.00 Water Conn.1 50 - ()n Woter Meter 6r)' 00 '??;i.r?0 Road Unit Torol L1-749 . 50 on the express conditlon thai ond City of Eagan Ordirances. Permit No. Permit Holder Misc. Permit No. Holder Plumbing H.V.A.C. l ?J?.?V1Q(;lr II` Q? Well Water Disp. Sawar Electric ( QS , ? ? tS Inspactlon Dats Insp. Other Footinps Foundstion Frominp Rou? Plbq. -Z 1t? •? - Rouqh HVAC Inwlation `?, Final Plby. Final HVAC Final y ? i i / b Wour Doscriba Location: . Nhll Sower . Pr. D'ap. CITY OF EAGAN Remarks t--ij, Addition • CQACMlAN HIGtII.AND3 Lot 64 B1k 1 Parcel 10-18075-8d0•,O1 owner streec 3236 EVERGREBN DRIVH State E+4GAA1 NQ'1 55121 Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. 'l u STREET RESTOR. /-G 1974 11 11 GRADING 1007 1986 354.14 35.41 10 ?o ?6- s SAN SEW TRUNK 1968 Paid und r rcel 10 2754 -Q! -03 SEWER LATERAL 1984 ml tt • WATERMAIN 11 1972 Paid undi nr Cel 1 27S -010-43 WATER LATERAL 1975 u It Ir • WATER AREA 197 of tr ef t tt or » STORM SEW TRK 1975 of ' STORM SEW LAT CURB & GUTTER 51DEWALK STREET LIGHT 250.00 37647 8-2-83 WATER CONN. 450.00 n 1? BUILDING PER, fklll SAC H 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 , _ �, �� 3 �3�, 3 �,13� 3� ��(j ��3�� d�� Use BLUE or BLACK Ink �----------------- � 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