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3266 Valley Ridge DrCity of Evan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 Date: 4 9(D • a4 // Site Address Pe A Applicant's Printed Name nt's Signature Use BLUE or BLACK ink 9e74 Permit Fee: it 2'29 / , 75 ( Date Received: ('•d/ -1I Staff: Permit #: 2011 RESIDENTIAL BUILDING PERMIT APPLICATION CALL BE FORE 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. Wn+w. gopherstateonecali.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 appvtgvat elan Page 1 of 3 .... , • %JIM . RESIDENT / OWNER Name: a ,., - - /. hi _ , _ - // a iii Phone: 76.3 - `/y9 - 9/np Address / City / Zip: i . • 4 ` /O • Al Ali. y ♦ a/ / Applicant is: Owner x Contractor TYPE OF WORK Description of work: RQ - -r-P Construction Cost ` _5.23 99 Multi- Family Building: (Yes X 1 No ) CONTRACTOR Company: f t n r ;,s - kr PJfx 67 C Contact i Pa ')-) I _ Address: 59 7 (o llobc_ 1r e_ City: 3-I-, p ; , t State: H N Zip: //O Phone: S/ - 76„1 - 9 .295 License #: c615/g Lead Certificate it INIA I - aQ9. 3-0 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 bf the information may be classified as non-public if you provide specific reasons that would permit the City t conclude that they are trade secrets. City of Evan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 Date: 4 9(D • a4 // Site Address Pe A Applicant's Printed Name nt's Signature Use BLUE or BLACK ink 9e74 Permit Fee: it 2'29 / , 75 ( Date Received: ('•d/ -1I Staff: Permit #: 2011 RESIDENTIAL BUILDING PERMIT APPLICATION CALL BE FORE 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. Wn+w. gopherstateonecali.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 appvtgvat elan Page 1 of 3 Aug 18 1510:57a Sunrise Remodelers 651-762-9395 p.8 Use BLUE or BLA�K Ir�k 1 ForOfficeUse ----'---� 1 �j • � Permi�#: J�� I � � I �It 0 � �III � ��,n��:�� ; 383Q Pilat Knob Road � I Eagan llllld 55'!22 � Date Received: � Phone:(651)fi75-5675 . 1 � Sta�f: � feX:(651)675-5694 � ( ' ------------------' �-2r'VIGc.�` I ', �, �ieiK��+ �.;�-j c� �'��.�c.n •c��,� 2Q15 �/t�'�SIDENT/II�� U�ILQIiVG I�Ei�91i61' �►PPLIC�4T�0�! C."E�L_!'� ��/�� C 4'v r'i �)�%t1 S-C� Qate:�'f�ri''i � Site Address: y �V 55/� unit#: __ �_. --..�.�_.�.,z_�..x_.z�, -�;n-�Fi�c��:3�5�j ��G� o; � �a, x3��-�', 3�-'i� � ' FVame: Phone: � �esiden�l (}yu�gE � Address I City f Zip: - . . _ ; : . . : � Cvntractar ` Appiica�is: Owner �^ '4'�,.L. .O�11VOPk ' Description of work: �-�; � �v�i - �'R� CJ � Co�struc#ion Cost: � ��; dC%� Mufti-Farnily Building:(Yes�I No_� q_ � , . . ...:.:..._..:....-.-.._._...-�_..._...,...�,..,.�.._,.c.�.��„-_.:.:_.,.,._�....._�..�.....,_..�..,r — ._,�_.._,_..w.�...,....�.......�.....__.._..___�-.e_..�,,,....�........a,.� ,�_4 �. i � ' Company:�j Li Y� tr; �•� i"��vY1 �.c�!-�:S Contacfi -J C�� •'�-c'-'� �::.� - y j � IF-� , � �ON�i'�C$GT Y. Address:� `t� �G' �-ti��-� �--�t i/�-� �+ty: �i� �-- : State:,�'1�1(1i Zip: �t/ !U phone: Ernail: i Y1'-1r� ' S_e��,r: ��y P��✓��c��e►�s, � ; :ccr+. ; ; e.icense#:�,�{�„�� !�_d.ead Ceea€tcate�:„��-.��I �� _ . �.:__....._-,..__.,_........>._,.._..�.w�..._.___._..._.__...._.__-.___.�..�-�,.�,._r�.v�..,�...�...,.._ --Y_.._.__.�.,�_�._�__._�......._. .._._� ` !f the pro�ect is�xempt from lead certification,please explain why: k ��,n^fiz��COMPL�TE THIS�I�EA ONLI'�F C01�STRdJCT6NG}�NEUV BUILDIN� � fn the iast�Z moret[�s,has the City ot Eagan issued a permit i�or a simila��slan based on a master pian? � Yes No If yes,date and address oT master p�an: - Lic�nsed PiumDer• Phos�e: � �fechanicaE Contract�r. Phone: — ; Sewer�Water Contractar. Phone: - , � �ire Suppressioes Contrac�or. P�o�+e� __ � , _..,,s:�.�.....�r�._..�,..V�..,..��.,.,_...�,_�:,.,.��_.,�._.,.,.__s._-.u.�..�,:.:,._._._W_�_..:�.�_..,.. �-_.��W.....�.L.....,.9.��_�.._,�..�_. ��1i�d�TE:Plat�s and suppo�Eing alocumen�s fP�a#yor�sa�mi�are consiafered ta bs publdc informatior�. PO�f01i5 6� ; . �he ie��orma►uon may be�Jassi�ed as�on publ�c�f yoe��r�v�de specific r�asons tha�woud�pe�dt th�Cit�to , ; .__._aonc/ade fl�att�ey ase_trade secrets. � . � ..:.....,�..�.._......:-:.:_ ..,.....�_,,,,..,::.:..:.........�....:.,�....L_..�<��..-_wu,.a_..�....,,�._..._��..F......_ -.:.._...,..:....,..._...,..._-,,..::...:.:.:: -�.--:- . ... .... . ..,_....:.._�.:..-..,::.. .,._....,:.:._, . CALL 6EFORE YO�1 DIG. Call Gopher 5tate One C�I at(659)454-0002 tor protection against underground utlluy damage. Ca1148 hnurs befiore y�intend Fo dig to receive locates of�cndelground ufliGes. www.Qooherstateonecall.ora I F�e�'e6y acknowledge thal Ihis informatian is complete a�d accurate;that the�vo�ic vrN be in corrtormance with!he ordinances arxt codes of the Gity of Eagan;that I understand tlris is not a p�tit, but only an appllcaUen for a pe��nit,and wo�C i� not io sta�t ovithout a petmit; that iha+xorts urtli�e in ri accordance with the approved plan�the case of work vdnich requires a review and apprnvai of plana Exte�ior work authorized by a buiEding pemait Issued ic�accardance with t7�e AAinneso9a State Building Code snust 6e completeal wi�hin 980 deys oi permit iss�ance. ---- • x �` {�.�?-�•Y-� c'�1 � --� Applicant's�ri�eted Naene A a s ignature . ,% Page 1 of 3 Use BLUE or BLACK Ink r----------------"'� I For Office Use � . f � � I Clt of �� a� j Permit#: � � � � Permit Fee: �� 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 APPLICATIO�� Date: Site Address: � v�.� S� � .�c��a� �Unit#: Name: Phone: Res��i�� ,/ n QW�� Address/City/Zip: ��5� Y�L��H IC�Dfr6 .DR, �6r��. `�N. .$�.5��3 ' Applicant is: Owner Contractor ': Description of work: ��P�A[ s� �I�1dL�46�� T�°�r� of W��k w ' Construction Cost: '� 3 Multi-Family Building: (Yes�/No� ' Company:��/�y� �� wS�_ LLG Contact: S'T6b� �t�/�1�cv � � � �� Address: .�S�gO �D�" ,�Lt� City: (.�vr�� u.S �{?�i1'�ra�0�' ' ' State: 'l�N Zip:155�� Phone: �S/-aNs-03/� Email: SJoNn+Sc�B c.,��ar�ku.s•�(r�it�t��. License#: rl� (� Lead Certificate#: Nl� If the project is exempt from lead certification, please explain why: N� ( q�c,�ti�ti�r 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: ' I11D7'�:P��and s�tp�Zn�l'Ing t��curn��ts t�l�#yr�u�ubmi#are cvr��ed to be pr�b��a#or►�atran. f�c�,r�rt�,�t' ' th+e in#orm�tio�a r�ray tie ctass�f�ed as t��nyv�bf�c if,��u p�ro�t�ale;�i�"f�rea�art��aa�vv�d�e��`li��#�� ' 'ccir�c��d�e tt��t�1� are tra:de sec�s. 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"7$V� ��I�NSo,� x Applicant's Printed Name Applic t's Signature Page 1 of 3