3315 River Bluff DrCityofEaau
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694 / S3/6; �.� /� ` / / 23
Date: 4 • n • a0 // Site Address:
x ��oe/I te.601
Applicant's Printed Name
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
A .pl nt's Signature
Use BLUE or BLACK Ink
Permit #: ClO 9)*(9
Permit Fee:
Date Received:
Staff:
RESIDENT /
OWNER
TYPE OF WORK
CONTRACTOR
.3/3 At i RJa Pr
Name: Om
Address / City / Zip:
Applicant is: Owner x Contractor
Phone: 76.E - Hy9 - WO()
IL Ad
Description of work: RP ,�f7)p
Construction Cost: 49y G //. $ 5
Multi - Family Building: (Yes X / No )
Company: . t ,t o ke ,h 61 o f ) 7 - Contact:
Address: 59 760 14
State: M f\J Zip: 55//O Phone: 6 - 76 - 9029'5
License #: c15 /5 /g
City: it Pit c1,
Lead Certificate #: NAT-- 3 -0
�I Pe l
lithe 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:
i TE: Plans a
nfor
Unit #:
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. wvvvv.gopherstateonecall.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
Page 1 of 3
V�l7�i L71.YV V� Y�/'��.ra�����•
r-----------.�_._—_—
1 For Offfce Usa �
I // �
��`7� I
C�t af �� � ; PeRnit#:_ ' S I
� � ' o� � ,
I PeRnit Fee: ,
3830 Pilot Knob Road � I
EagBn IIAN 55122 � Dake Received: �
Phane:(657)675-5675 I �
Fax:(651�576-5694 ' � Staff: j
'�Yr,CZ.t, E �� � . �I�'•l��y C..��� G' �,4��;CY1 ' _.—__..�
C�vr ��_...—_--�.__--
2015 RESIDENTIAL BUILDING PERMIT APPLICAT1t]N
C-e�.�;:,r' �3(,u�'-� Tc���+ h�� s-c� .
,
Qar�:?�-/�'� r? Site Address: 33 i 3 ��v��t�,�r I,c,���'j�-:v'�e., 55�a��n��:
��..'�,� _ �. s ,��i 5�, 33 � 1, '3� I �' �33�� 3 3�-3 � '
; ;�v+c.l-N ;
Name: �hone: �
� Residentl ;
; pW�� ; Address/City/Zip: r
;
�S 3 Applicant is: Owner ,,,�,�Cvntractor �
.._..�_e...�_......_. .�....�.�.. ._o_,__._.. ..,.,,.._,_..��
Y 1 �
T e of Wor1c � Descri tian of work: ��� C� n 4� �
r yp • p
� °'' � � :
4 ; Construdion Cost: � ��: �v�� Multi-Family Building:(Yes 1 No !'
t.......�.,,�.,,p.,.-.��,.�,...,__ .�._...�.... . _.,..�-�.�.-_�.�.v. _.�.�.._. �-�..�.__. �
� ,� ..__. . . -
� �s Cornpany:Cj�.'�Y1 r��{-' 1'S-�w1 �c�-z.�t'S Contact: ,J c�(?.� �-�'_� .��iY 1
� At�dress:�-l'� lG' �R:��� �l 1/1-� Cily: �'�'� �t�t 1
, Co�rtractor (' �
� State: �1/t� ZEp: � C� !v Phone: Ernail: �Yi`'t'v P S-t tn r� ��'2�^�-�'��.�5�
t ! i - (���T-�a :���.
� License#: � �V � i S ,� �_Lead Certif+cate#: '� �3� � °
�....,,........,..�F-,....,...F�.,.�......._...e..�.....�..�.,e....�.... _,._. r.,.y..._.,,.,a�.,.,�.,..,.�,�..�..,u,....,,....s.,. i
? �f the pro�ect is exemp#fcom lead certi#icati�n,ptease expiain why:
;
i :
�---�-- ,,,�__�
GOMPLETE TNIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
€ !n the tast 12 months,has the City of Eagan issued a permit for a similar plan based o�a master�ian?
;
5
' Yes No If yes,date and address of master plan: '
t
� Licsnsed Plumber Phone• �
�
s '
i
: lNechanical Corrtractor. Phone: '
�
�
; Sewer 8 Wate�Contractor: Phone: `
i �
� Fire 5uppression Cor�tractor. Phone: a
� NOTE:Plans and s�pportfng docurnents thatyou submitare considered to be public ir�format+on. Potfions of ;
r the intorr�ation may be cla�ed as non public if yvv provide specff'rc reasons that wo�ld permit th�e City to �
�y�� --- ----.._.�...,�..�..�. conclude that they are tr�de secrets. �.�._._. ..�...-
CALL BEF�RE YOU DIG. Caa Gopher S1ate One Cali al�651)d5�E-OD02 for prolection against underground uliliy da�nage. Ca1148 haurs
before you iMend to dig lo receive locabes of�dergraund utillties. wwir�.ga�herstateor�ecall.om
I here6y s�[cnowledge that ihis infamation is compiete and accurate;that the work wiil be in coaformance with lhe orclinances and codes of the City of
Eagan; that 1 understand this is not a permit, hvl anly an application iw a permit, and work is not to sfart without a pennit;that ihe woiis v,riEl be in
accordanfle with the approved plan in the case of work whic�h requir�a review and�proval of plans.
Exieriorwork authorized by a 6uilding permit issued In accordancewifh fhe Minnesota State BuUding Code must be complated within 180
ilQ�f 9f pV►lnit isal��nwo _...
x �,� Q,�-�.�,,�' c,,.� -�_.--�
x
AppiicanYs Prinded�lame A s ignature
,` Qage i ot 3
Use BLUE or BLACK Ink
� r----------------�
I For Office Use �
C' � Permit#: /��//�� j
��� O� `���� I Permit Fee: / �J� � j I
3830 Pilot Knob Road � �
Eagan MN 55122 � Date Received: �
Phone:(651)675-5675 I �
Fax: (651)675-5694 � Staff: I
� I
2015 RESIDENTIAL BUILDING PERMIT APPLICATION
—� �'`-���.�
Date: Site Address:� ���.����� ���G� ��� Unit#:
, Name: Phone:
ReS�+C1+�� / -�
(}yy�g� ;�; �: Address/City/Zip: ��! � �iVLR13�u,FF� .�R • �6•�ii �1'1�✓� SS/�3
Applicant is: Owner �Contractor
� �` � ` Description ofwork: �C'P��4c� �'�r+-R.ia.t,-rf �oOlt,�
T�p+R 4��►�rk '
w
Construction Cost: � .3 Multi-Family Building: (Yes�/No�
Company:(_�}-i1,YVo�J Vil-U��w, ��Crri° d�Dizs�,L[,C, Contact: �7Fi1�'��0�✓�'"�
��������, Address: 357RD 91�� AI.E�. City: (_.�9'NNd�✓�i??�LS
: State:�Zip: SSUO Phone: �oS/-�y5- 03�/ Email: SJohtAtSav�CA+✓�N✓ki��/��qd�"� ns,c�„
License#: /J�� Lead Certificate#: N�f}
If the project is exempt from lead certification, please explain why:
,No Le� Pafs�.vr'
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:
�OT�';Pta�is.�r�d;sr��por�g t���ur��e�,s f��,�uu��br�i�are;c���d��ed to bE�trf�c�nai��.:Ptrrfio�s.�rf :
�e i�fvrr»�f1c�n�a,�y��cla�st�'ietl�rs��n pubt��if y�u}�ra���l�s�ecifrc r�p�s tt�a#t�c��l�l per��f�e C��°�. '
�or��ud�.t�a#fh are tw��(e�e�r�:
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.qopherstateonecall.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 180
days of permit issuance.
x S�'�VE" �uN�NSc�N x
Applicant's Printed Name Appli ant's Signatu e
Page 1 of 3