1568 Antler PtCity of kap
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
Permit #: 99 [ V
Permit Fee: -*Pa 7-50
9-6- if
Date Received:
Staff:
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit #:
RESIDENT /
OWNER
Name: Phone:
1 /
Address / City / Zip: 45-44 ,LT kr- ,K/ e, A J ,S.S/7 'Z
Applicant is: Owner Contractor 5= - %,,�j 60
tindv (
TYPE OF WORK
Description of work: pc -
Construction Cost: 1,2, c d O Multi -Family Building: (Yes ft / No )
CONTRACTOR
Company:A/t OCt t0 (. tR }rt9") Contact: II.., we =`/Yl
Address: /75/ L (, , 1Ry °te. F City: Rc . `J
State: M tJ Zip: 553%/`+ Phone: 7 (c — q20 3/0<)
License #: Qo/ 5” / Z_ Lead Certificate #:
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:
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 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
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, . • 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 . •proval of p
Applicant's Printed Name
Applicant s Si
ture
Page 1 of 3
City of Eaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
r
For Office Use
Permit #:
Permit Fee:
Date Received:
Staff:
\,icr5.1
I Lac .rc
9-)3,13
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date:qA. 377..613 Site Address: /4-66 I iCh / YG ( c'r
Unit #:
Resident/
Owner
Name: I) 1e tj oz 70LOAJ ffD/ t AS °C1:11-TZAk/Phone:
Address / City / Zip:
Applicant is: Owner ' Contractor
Type of Work
Description of work: Oc' p C- I.Z6P 4 C t t° -/✓T
Construction Cost: Multi -Family Building: (Yes / No )
Contractor
Company: / / /t't 16A10 6i Contact: .. ft'( t -C 60/Ue-J/1-11,
Address: ?I -7 & -' $7-L7 City: Utf� TZ Qi?- -(c
State: /-4/ti Zip: ;7'/U Phone: 26—?, `/20 ' ..-/ 6 7
License #: i6 c 6:61 070 Lead Certificate #: .s 6C "see -pc -1
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
8i✓n -1 /77e 0?96 z L,,ev>
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 CaII 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 autho tzed by a building permit issued in accordance with the Minnesota State Buildin. .de must be completed within 180
days of per ance(
Applican ' `Tnted Name Applicant' : ignature
Page 1 of 3
Cityofaall Receive°
3830 Pilot Knob Road O
Eagan MN 55122 10,1
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Use
/f j� d
Permit #: /o'� 3 ✓O
Permit Fee: 4/44, .Qb-
Date Received:
Staff:
6- -
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address:
Resident/
Owner
Unit #:
Name: f z bd-L /�.•►DhCf%
Phone:
Address / City / Zip: /5-(C/ , 1i'Z7
Applicant is: Owner A` /Contractor
Description of work:
Construction Cost:
Multi -Family Building: (Yes , / No )
Company: #4l11C/'icc,^ GlC Contact: ilk
Address: 05( City: Kw' ZCC
State: f'i dVZip: / S7/,( Phone:
License #: &C- 6i70? & 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:
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 the 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.00pherstateonecall.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.
,01/7/4-e-/ C �+ri
Applicant's Printed Nam
x
Appl cant's Siure
Page 1 of 3