4646 1/2 Penkwe Way
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For Office Use
+ y iI Permit#: /(Q Osla
E AG N
Permit Fee: 940 Q
Date Received:
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 I TDD:(651)454-8535 I FAX:(651)675-5694 Staff:
buildinoinspections a(7.cityofeacian.com
2020 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 172-1'1-o D Site Address: q6 4l(P lz Pl rr i�'i= 1l9 Y 6-A b4 ra filo Unit#:
•Name: > ��G Y UIZbM"c, Phone: 6/97 " 615 6 5/7
Resident/
Owner Address/City/Zip: ��74 77 Pel4 tctvc (Amy lr4 6'? Al5:5 1
Applicant is: Owner Contractor
Type of Work 4,Description of work: fN,.$ -14-41Gl 64-3 1;'f"�/ 1. ,.#4t iv/3 C 2 T
Construction Cost: 7 6, to Multi-Family Building: (Yes /No A'Z)
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Company: (-0r / c'7 !n Contact: �[�/[�c�r} 1'
V l�
Contractor Address: �1'-/ .V' t1- b�G��d City: r aL 5 W&Yz Tl
State: W1 Zip: S`/O/i Phone: yea 7o E'50 Email: 12(444.Gc';1rc�,-7/ Oes :, C4 6.141,1,ty
License#: m 6 (o ti 5 '' Lead Certificate#:
If the project is exempt from lead certification, please explain why:
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:
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 CI to conclude that the are trade secrets.
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.citvofeaoan.com/subscribe.
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.
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.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 approval of plans.
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Applicant's Printed Name Applicant's S natu