775 Cougar DrCity of Ea�all
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use
permit #:
Permit Fee:
Date Received: 7 `31 -IL
Staff:
7
? 2012 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 7- 3P12--- Site Address: 715 C ou5 c ' D r ' Unit #:
CONTRACTOR
Name: 1csfl (C VW/ �'� Phone: 7 , --Y7d-6 3
Address / City / Zip: re ( � /il j�c9 ,^v.c �S \,iik,2J
Applicant is: Owner Contractor
Description of work:
Construction Cost: / 1* -06)
Mufti -Family Building: (Yes / No )
Company: 'Ld GjhM��r= G15744444-1 Contact:
Address: /jl jJhrt5e/q '1/46/City:
State:
N Zip: c6-5-3
License #: r G 2-6 5 75 er
Phone:
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 for a similar plan based on a master plan?
Yes No' If yes, date and address of master plan:
Licensed Plumber: Phone:
Phone:
Phone:
Mechanical Contractor:
Sewer & Water Contractor:
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 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 Stat uilding Code must be completed within 180
days of permit issuance.
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Applicant's Printed Name 1 Appli ant's Signature
Page 1 of 3
446
City of Eaaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
Permit # o&-4
Permit Fee: e2e.00
Date Received:
Staff:
// / 2011 RESIDENTIAL BUILDING PERMIT APPLICATION
Date:(V / / / Site Address: ( / CO uocr 0(‘; it
Unit #:
RESIDENT /
OWNER
1 v
Name: )U L..� c 1.0-^-e.—� Phone: t --'42.31s 9 '.9x7
y
Address / City / Zip: / 2019 4' i�''r�I c / 31 d Ai� ° L t Ma S—X
Applicant is: OwnerContractor
TYPE OF WORK
Description of work: %e fp ! G CQ- W oo cX c),) --e f L e.. ,,\ L»•4 V; Al .5 y�/''k
Construction Cost: /00 O. 00 Multi -Family Building: (Yes / No/ \ )
CONTRACTOR
Company:�4-,. 6 Oa L53bo 9 ✓le-- Contact: ) 0L -... 71/1c.1-10 n e.�
Address/? oZ 7 Co City: PC l ° rLQ J
State: 1) Zip: 3 3'7c Phone: LO i a' 3 t? ^ '7,9"-) 7
UC_
License #: 3 / V Lead Certificate #:
Does this project require Lead Remediation? 0 Yes ` INIo (see Page 3 for additional information)
If no, please explain:
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:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
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 dig to receive locates of underground utilities. www.gooherstateonecall.orq
1 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 approvof plans.
x �h r� � Lorvt,...)
Applicant's Printed Name
x
Appy cant's Signature
Page 1 of 3