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4134 Ruby Lane ÷ þýýüûúùúùúû øüüýý÷ûö÷î ë é ääü÷òò ë é þý ÿþýüûöùáùøöù äù öùýüûõô öùáùøöù äù ïù âïùýüûïÿäÿùù ùõÿòþùçòõÿòþù â ÛðïÜÿù ý éù õ ïûïõ ßß ë ùòúîö øàùöáìæ è ë è ë óø ÿùðù úæè í èí ò ñ ðï ûû Úòúù ÿòþ ýðò ù õéù èéçÿþü ïûïõ ïõ îßìß ëÙß ðùþüô ððåùðûûððäùòùù ùòûüôðûûþ äï ÿ÷üä ãùè ûûà ùò ÿùÿü ÿù Sep 30 13 08:55a LS West, Ilc 9522368445 p.7 Use BLUE or BLACK Ink I For Office Use t My Permit: of Eap I ; 1 Permit Fee: 3830 Pilot Knob Road Eagan MN 55122 Date Received: ; Phone: (651) 675-5675 I I Fax: (651) 675-5694 1 Staff: 1 I I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: idlOt (3 Site Address: 2D 911-1, 4 IL LHle.- Unit: 1 Name:Wii 11~~~reW&45 dht) xl1ir~60 Phone: Residentl Owner Address / City / Zip: Applicant is: Owner Contractor W! ~d~'A~~i ir~✓t S~ti~tg~~S " r`IrU.`1 Type of Work Description of work l ^eAr- dl` Construction Cost: J~ ~l 1 Multi-Family Building: (Yes ! No j&k lie Company: Contact te &AJLrJ e Contractor Address: 2e u~ keOtle- City: kd~g1ieJ State: Zip: 5 U '7 Phone: LJt d ' ~71 - License bU J L1 D .1 Lead Certificate 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 fora 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. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dlg to receive locates of underground utilities. www.aooherstateonecall.ora I hereby acknowledge that this information is complete and accurate; that the work will be In oonformance 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. Exterior work authorized by a building permit issued in accordance with the Minnesota State B dldigg Code must be completed within 180 days of permit issuance. 91 x sit ti lN/! SL J. ' x Applicant's Printed Name Applica s Signature Page 1 of 3