3859 Windcrest Ct
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Permit Fee
3830 Pilot Knob Road t t
Eagan MN 55122 Date Received:
Phone: (651) 675.5675 i ;
Fax: (651) 675-5694 1 Staff.
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2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 2-~ ( Site Address: Unit
Name: jAJ 4 tjI) 13ZJ`t,3 ~tgZG,)C ! l 3&-,Qhone:
Resident/
Owner Address City t Zip: ")C rrZ~-L OaA-) S ;;Z-f ?4
Applicant Is: Owner Contractor
Type of Work Description of work:~~
Construction Cost: Multi-Family Building: (Yes 1 No )
Company. A` Contact: 11~ u t., R ..r►,~, e ,r -rt t
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Contractor Address: -i Cu V ru d2tP~ i t city: 07 0 Ao
State: W( Zip: J L~ Phone: L~1 Z
License 4 !5 3-b 8 Lead Certificate -A " - $ ` -1
If the project is exempt from lead certification, please explain why: (see Page 3 for additional 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 & Water Contractor: 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.
CALL BEFORE YOU DIG. Gall Gopher State One Call at (661) 454-0002 for protection against undergfound utility damage. Call 48 hours
betwe you Wend to dig to receive locates of undergsowid uhhties
i hereby acknowiedge that this inforrnaton is complete and accurate that the ::pork will be in conformance with the ordinances and codes of the Gib; of
Fagan that I understand this is not a peimil, bit only an apphcation for a pormil, and.vork is not to staff wilhout a pormii. that the work mill be to
accordance with the approved plan in the case of work w ich 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 issuance.
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Applicant's P ted Name Applicants ignature
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����MI+C''S5122 � Date Receiued:� F c��- 1� t
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I�ate: �� �r1 site:A�#�iress: ,�,�t �f�l���.'IEtC~'�"'�` f'o�✓�— un�t�:
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3 �' �pplic�n#is: C�mer �Ccintractt�r
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;��, � D�Scription of�vork: 4 t�-�
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�•� z Gc�nstruc�ic�n Cost:��� Mul�i=�`�'nil�Suiatii�tg.�Yes ' !Nm��.
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If�he pro��ct is exempt frarr����ad+c�rti�ca��t�n, please explain wh�:�s�e�age 3�c�r additiortai inf�rrrnatlon}
Ct?NIPL�TE TNt3 AC�Ea4€3ML�IF CtJN�T�tUCTI�t#a�4��1�"IN B�tLL�tl�lt`s
tr�the l�st 12 rntsnfhs, has#he�i#y of E�garr�issuetl a p�rmlt f�r a simiirar pl��t bas�d�r�►a m�.stee plan'�'
�,lf�s :�,Nrt If�res,�ate�nd atldre�s of masfer plan:
Li�ens�d Piumb�r� Phone:
Nte+chai��cal�i��tractoe. Phone:
Sew�r 1�1�1�tetF����ract�t: Phesne�
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CALI.BEFC��E 1€QU�IG. Gal�Gapher 5tate�.1ns cail�t(ssi)4S�-aao�f�r protecq�rr ag�inst c�nder�tt�utxt ukit�t�r aamage. �an 48#�i��s
befor��u fntend#o dig#e�,rec�iue IoCa�of urtdergrbund ufiliti�s. �..9cr rstaEeonecall.orq
I hereby ackt�anAecfg�that this irrfottnation is�atrt}�lete artd accurats;#hat the aroMt wiit�Se in�nfornt�n�e wittt Eh�brd+inan�es and r�ci�t�f�.G€ty tif
�agan; that;{und�t�nd this is not a p�rrrtit.:but c�srly an�ppiic�tit�n#or a perCnif,�mf r�rit is not to sf�tt�Arithout a pem�tit; tFiat fhe work:+nntt b�in
ae�c�rd�nce vufth the approaed ptan in the c�s�o�vu4rk a�tti�h requi�s a review and appir�u�l ot.p�ans.
E��iar work authoriz�ad by a bnilding y�rinit'rssued 1n�ccordarl�e wittr�the Minn�sota�#a#a'Bultdtng Code must Ei�cam�3�s�1 witF�"rt�'!�
tlays of perrnit issuanc�t.
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�p�fi�ar�t'�,Pr�rttted Name �� �Ppli��ti � ��r��#�ce � � � � � �
Pag�1�f 3
'f2� ����-��� � , , DO NOT WRITE BELOW THIS LINE t ?j1��j�
.-
SUB TYPES
_ Foundation _ Fireplace _ Porch (3-Season) _ Exterior Alteration(Single Family)
_ Single Family Garage _ Porch(4-Season) _ Exterior Alteration(Multi)
_ Multi � 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
ration _ Fire Repair _ Windows _ Demolish Foundation
place _ Repair _ Egress Window _ Water Damage
_ etaining Wall 'Demolition of entire building-give PCA handout to applicant
DESCRIPTION
Valuation 3�'J Occupancy � MCES System �""'
Plan Review Code Edition �a,� SAC Units "`�
(25%_100%✓ ) Zoning � City Water -�'
Census Code �3�l Stories ^' Booster Pump --�
#of Units 1 Square Feet �GO PRV �"'
#of Buildings / Length p Fire Suppression Required �
Type of Construction � Width �
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
� Footings (Deck) Final/C.O. Required
Footings (Addition) � Final/No C.O. Required
Foundation HVAC Gas Service Test Gas Line Air Test
Roof: _Ice&Water _Final Pool:_Footings Air/Gas Tests _Final
Framing Drain Tile
Fireplace: _Rough In Air Test _Final Siding:_Stucco Lath _Stone Lath _Brick
Insulation Windows
Sheathing Retaining Wall:_Footings_Backfill_Final
Sheetrock Radon Control
Fire Walls Fire Suppression:_Rough In_Final
Braced Walls Erosion Control
��
- Other:
Reviewed By: '� , Building Inspector
RESIDENTIAL FEES
Base Fee �'�
Surcharge
Plan Review 'r 7 ��
MCES SAC
City SAC '
Utility Connection Charge
S8�W Permit&Surcharge
Treatment Plant
Copies ����
TOTAL
Page 2 of 3
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