1630 River Bluff CtCity otEagau
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675-5694 & / - 54/r 36
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: L( man • ap// Site Address:
GALL BEFORE YO 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.gopherstateonecali.org
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 app Val n
x ,oeJ PPA -e.cso
Applicant's Printed Name ..�..«�
Signature
Par- 3( Use
Permit #: ! F iS
Permit Fee: H' 39 g 75
Date Received: y - l ! J
Staff:
Use BLUE Or LACK Ink
Page 1 of 3
. .... ,. .. 11 . �. VIII(if:
RESIDENT t
OWNER
Name: Ornp j'`ir•nnayr:ryt ( 41 r. Phone: 76 - 'Ng - 9 /nn
Address / City/Zip: i , , d t. ` _ / . 4/. F91111 • V
_
Applicant is: Owner X Contractor
TYPE OF WORK
Description of work: Re.,- -P
Construction Cost i /, 5x23. 99 MuIli- Family Building: (Yes X / No )
CONTRACTOR
Company :, co n r,s� ke PJ(X3 di �. Contact: 5 L( Pue - sc
Address: ,5 7 6 Iiobe. /n r_ City: 34.. Pa u'
State: M N Zip: £5//Q Phone: 65/ - 7601 - 9a 95
License #: o /5/ g Lead Certificate #: NA axi .33-0
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
Yes No If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, 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 o
the information may be classified as non-public if you provide spec reasons that would permit the City to
conclude that they are trade secrets.
City otEagau
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675-5694 & / - 54/r 36
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: L( man • ap// Site Address:
GALL BEFORE YO 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.gopherstateonecali.org
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 app Val n
x ,oeJ PPA -e.cso
Applicant's Printed Name ..�..«�
Signature
Par- 3( Use
Permit #: ! F iS
Permit Fee: H' 39 g 75
Date Received: y - l ! J
Staff:
Use BLUE Or LACK Ink
Page 1 of 3
Aug 18 1511:01a Sunrise Remodelers 651-762-9395 p.13
Use BLUE or BLACK Ink
r----�'-----__—_�_i
I For OFflce Use �
1 �
�' � Permit#: /���(� � I
�b� O����LLli � _�� �- ,�t`} I
I Permit Fee: �
3830 Pt1ot Knob Road � j
Eagan MN 55122 � Date Recewed: �
Phone:{657�G75-5673 , � �
Fax:(651)675-6694 � Sta�F: I
'�Y r I�.i ' �� � , �(���i�� C:!"` G' �4�1.7C,n G.�:rY� !----------------''
2015 RESI�EIVTIAL BUILDING PERMIT APP�ICATION
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3 Name: � Phone: �
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� Resident! - s
i Qy�n� � Address 1 City 1 Zip:
; s Apptica�t is: Owner �Conlractor t
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� ' Des cripEion of wQrk: ��: C� /�� ''
� Type of Work � �
� a Construction Cost: � 1�: �C�Q•Q Multi-Family$�.olding:(Yes�/Na�
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t � Company:�j�:'�Y1 ir ��-� ��vv� cx�_4-e�S Contact: .]t.',C'_.� ��--4-e.� ���1
} ; Add :����G' 'I��C:�E... �ci 111-�'_ Ciry: ��'• �t.�t � �
's Corttrd¢tor �ss �
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� � State: !L`Zip: � c/ /v Phone: Email: ��1�Yt� P'. �-�1�r-�'y r�v+ucl-el�e�.s�
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! ; L�ce�se#: L � (y �I� � � Lead Gertificate#: �7'3 �'�_3�'� `
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� !f the project is exernpt from lead certificatio�,�lease expiain w�y: �
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:
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= COMPLETE THIS AREA ONLY IF CONSTRUCTING A NE1N BUILDING
; In the last 12 months,has the City of Eagan issued a permit for a similar plan based on a master plan?
�
4
c Yes No If yes,date and address of master plan: '
; lice�ssd Plumber: P�one:
t
5 Mechanica�Contractor: Phone•
1.
a
iSewer�Water Co�hactor. Phone:
i
� Fi�e Suppression Contractor. Phone: ?
��NQTE:Plans and supporting documents that you snbmff are considered to be pub►ic inforrnatior�. Por�fons of j
' the information may be classified as non•public if you pruvide speci�ic reasons t/iat waLld pemtit the City#o '
,
;
� conclude that the�r are trade secrefs.M��.��.�- _ ---__-�����:
CALL BEFORE YOU DIG. Catl Gophar State One Call at(651)454-0002ior protedion against under�ound util9ty damage. Cail 48 hours
befire you irrtend to dig to receive locates of underground utilities. www,aonherstafeonecall.oro
I hereby acknowledge that ttvs ir�#ormation is camplete and accurate;that the vuark w�'ll be in confortnance with the ord9nances and codes of the£ity of
Eagan: that I understand fhis is not a permit, buE Only an appfication for a permit, and work is nol to ste�t witfiout a permit; Ihat the wodc wiA be in
accordance with t3�e approved plan in the case of woric which requires a review and approval of plans,
ExteNor woric authorizsd by a bufl�ing permif issued in accordancewith the M9nnesota Staie Bu�diflg Code must be complelgd within 180
daysofpem�itissuanoe. � _..._.
X ,�,l ��L.--�-E�i1r.� c r^� -.�.�
Appiicant's Pr[nted Name A � 's igRature .
,•' Page 1�f 3
Use BLUE or BLACK Ink
r--___---
--------�,4�����
I For Office Use
I
' � Permit#: � � � �S
Clty of ����� ,J
� /a�. �� ��
� Permit Fee:
3830 Pilot Knob Road � �
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I I
Fax: (651)675-5694 i Staff: i
2015 RESIDENTIAL BUILDING PERMIT APPLICATION
/ f �� �- /�=�(�
Date: Site Address: �/)�:((.0 E- �����'v��� �� �� Unit#:
Name: Phone:
I���iCler��' /�
(�y��;� , Address/City/Zip: ��o�t� }��Vl,��lt�,f^P Cl� �A�c'�,9�r�. 7'YJN• S5i�3
Applicant is: Owner Contractor
Description of work: �6Pt.�GE 1�3�2�cy3 ��
T�I'p@ c}�Ws�?rk
w
' Construction Cost: `� 3 0 Multi-Family Building: (Yes�/No�
Company: 0�1 �r+d GC.L Contact: STIy'L(�' ��5��
.
Cc�ntr�ctar Address: 3578o yo f`-" A�.� c�ty: c�.�uo� �.1�u.s
State:�N Zip: .S.SOD Phone:�O..S/-a`/5- d3�J Email: SJol+Nso��('�4�vo�11��lCs�th�+' ,�
License#: fV IA Lead Certificate#: N�9- �
If the project is exempt from lead certification, please explain why:
No l,t.ao �F�ss"rr
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:
11�flT�':P�a»s a�ads�p�c�rl�n�alr�ci�ts�ts��#yot,r�ub�are ca�asld�t�etl to:be pt�b1��`f�fr�r�a��a�a 1?i�,r���s of
' �he ir��rrna�#r�rr rn��!b�e cias��#'ied a�s��:p�#l����'yc��prrr�l�e s�e���"ic reas�t���rat ti�a�fd j�e�r��t��C�fy t� '
concfe►de`�i�at t�� �re�ad�se�r�;�. '
CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. Ca1148 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.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 780
days of permit issuance.
x -J�??I31/� �J d 1�t1 o�+J x
ApplicanYs Printed Name Applic 's nature
Page 1 of 3