1846 Cliff Lake Ct
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Oct 07 2014 0824AM HP Fax page 7
Use BLUE or BLACK fnk
� For Office Use r I
C�t O j Permit# I� ��� �
Ly f�a�a� ; � ;
� Perm�t Fee� � ` I
3830 Pllot Knob Road
Ea an MN 55122 �
9 Date Received: �
PhonQ:(651)675-5675 �
Fex:(651) 675-5694 Staff: I
I
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2014 RESIDENTI14L BUILDING PERMIT APP�ICATION
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Date: �"��� a Site Address; �� ��' i �� f��'l 1,�Yv � � ��� �
— unn ai'
Name: ��.��='��", ��/=. ,�r'�:� �`;, L,, �„-
Phone:
ResidenU
Owner Address I City I Zip:_' �h?yr�v-
Applicant is: Owner �f Contraclor
Type of Wcrk Description of work � ��• ��...- �� � • �' •�"�a.
/ 1 •�;
Construction Cost: �7 �Z��Y . � Mulii-Family Building: (Yes G°�No�
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Company• ��. . ,.' f =:���✓�+ r ``'�1'� , , Contact: �r'.��`9'`�-,t.''�.-�--�--..
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Contractor Address:���':.� '1.7;��l3��•.=e'; Fr��'" �'����>�:i�' � City: ��''��%��`c.-�.���
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State!°`�`�°�'� Zip: �°`5�`�,� Phone: � ���' '?,��� ���Email.���c,c;',_.��r.��*er'���^'si�C�'.��:��•�.�r•+.
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License fiE: ,a�%~1��'� �'�,.� Lead Certificate#: .��''���"°�w%°"?.�� " �
If the project is exempt from lead certificatlon, 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 Eegan Issued a permit for a aimila�plan based on a master plan?
_Yes _No If yes: da4e and address of master plan:
Licensed Plumber: Phone:
Meehanlcal Contractor: Phone:
� Sewer&Water Contractor: Phone:
NOTE:Plans and supporting documents that you subm/t a�e considered to be pu6llc Information. Port�ons of
the Informatlon may be c/assffied as non public if you provlde specitic raasar►s that wouid permit fhe Clty to
conclude that the are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at 651)454-0002 for protection against underground utility damage. Cali 48 hours
before you intend to dig to receive iocates of underground utilities. www. o herstateonecall or
I hereby acknowledge that this information is complete and accuraie;that the wo�c 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 perrtiit, and woric is not to slart 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.
Exterlor ��hortzed by a bullding permlt issued in accordance wlth ihe Minnesota State Bullding Code must e completed wlihln 180
da pe�m�t+7ssuance. -�•---�:,�,:....: �,
X_ ��a���rF�-"�--- �""'`� j '.�..„�. .x .--"°�.i�-7.�,,.-_. ��-•.,'`� ---•.__„
Appllcant's Printed Neme ApplicanYs Slgneture j
Page t ot 3
Use BLUE or BLACK Ink
r-------------------�
I For Office Use �
• � Permit#: �� L 1�� I
Clt� 0� ����Il � � �����
� Permit Fee:
3830 Pilot Knob Road I I
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I �
Fax: (651)675-5694 I Staff: i
I �
2015 RESIDEMlTIAL BUILDING PERMIT APPLICATIO� �.��� �.
� L /, �/ C� � M
Date: rL ��l�S SiteAddress: ��� �lf �� '-'""^G �o� � Unit#:
��, �.� ° � Name: H� Vil YY __ _,. ��n��.�,.��,m ��.v✓�.�w.��ew,..�..�.�.., �,W,�.....�,.�Phone:�,..- ��.�.,..�..�A�,.._.��.,�..�d_�
S
� f�tes3�l��#1
� ���gr � Address/City/Zip: ��' �
� �
�
� Applicant is� Owner Contractor
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� ��<.��.,�...�.,�,��..�,.,e� .�..� .,�,..�.,� �
� � Description of work: ��✓� ���
Ty�pB d�'l�lori� �
�
� � Construction Cost: Multi-Family Building: (Yes /No� �
£�_.,� � ��. � Com�an �.,�.�.��.�n��a��„_,a�G�d 1 �hc. Contaci: L��.I ��t �� �-�-, �.�_��.�„_..��
� � P Y•� ,
� ` Address: JS�'b �'L.��?tM'� �/� � Sui�e u.�1/ City: + � � � �
COhI"�f'�CtO�' �
� � State:�Zip: �Sy�� Phone: '7�3-SS� .�D'�� Email: ��_���.I�r�n,cy����"1-�
$ ,
� �G �o� ��.�
� ( License# Lead Certificate#
��..P,..��,� �.�.�.�..,w,..,�_�..��.,,.,...w�Fa___.�,�._�.�.� ,..���.... ..M.e.�_ ...,,.n,�,�.�...,... �..., .,..d,,,.. �._��.�.,�.M�.� w..�,.�,.�,.�....��.,w,._.�.�.._,._..�.._..�._.�.w..�.�.,_..��.�w..�..._.,....
� If the project is exempt from lead certification, please explain why: � �
�,e..� .,.�..ti.�.�..��_...� . �.a._..__�,.�.a. _...w.�..� r�.��w�...�_.�...M...�.,.�..�.a. �.M...�.,.�k..�..�.�...�...�..,�..._..�.�..�,�.,.,�..a..,..._.�.�,.�
COMPLETE THIS AREA ONLY I� 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 )f yes, date and address of master plan: �
i ;
; Licensed Plumber: Phone: �
Mechanical Contractor: Phone: �
� Sewer&Water Contractor: Phone:
�� Fire Suppression Contractor. Phone ,�
�°�11��3T�':Pl��s a�d��vr�i��o[�r.t��:r�ts t���yow�s�br��a�e co��i�ed to�p�b��r���#�. f�o�o�s af �
� ` r��i�a�`�r������r�e Gl�ass��d a:s r�on p�bl��i�y��pro�it��s�e��r�+��s fi�a,���t psr�i�th�C��y t�a �
���.� c�n�.��le�at t�e��-�trad��ect°e�s. �
CALL BEFORE YOU DIG. Calf 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.qopherstateonecaA.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 noi 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 S t Building Code must be completed within 180
days of permit issuance.
�_
X �(.!�f�Y(�(' ���.� X
Applicant's Printed Name Appli s Sign ture
Page 1 of 3