4420 Lakeshore TerRESIDENT OW N R /
Name t i r e Lake_ J hte Phone: 0 1 2` 3/ - b ` oy3
Address / City / Zip: 4 1 4 120 4' �Z2 Zak Sh /ecr ti/S � 1-t'- tit Cf -
Applicant is: Owner X Contractor
TYPE OF WORK
Description of work: ,D 1woC
Construction Cost: 27,oco Multi- Family Building: (Yes / No
)
CONTRACTOR
Company: i Qw an ilbeisti Contact: 446 /0 /
Address: 2 /100 0icciewk eci. S4-e. 1b0 City: 0 Nr itS✓I &-
State: ! Zip: 55337 Phone: 952-707 - L951
License #: 1 , 14,9 38 3 Lead Certificate #: NA r- 33 225 -1
If the project is exempt
from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
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:
_ Yes
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
i
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City of Evan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
Permit #: /0// 7°0
Permit Fee: / % g• o V
Date Received:
Staff:
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
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Applicant's Signet,
Use BLUE or BLACK Ink
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Date: Site Address: Unit #:
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 ns.
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Applicant's Printed Name
Page 1 of 3
Use BLUE or BLACK Ink
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I For Office Use �
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C��TT O� j���n n Permit#: � �
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I Permit Fee: C���� �
3830 Pilot Knob Road � �
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I �
Fax: (651)675-5694 I Staff: I
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2015 RESIDEN.TIAL BUILDING PERMIT APPLICATION
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Date: Site Address:
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� � Construction Cost: Multi-Family Building: (Yes . /No� �
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� 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:
�N�JTE:P���S a�l?t�5U��741�'I�)Q,dOCIl��I�#vt'�h�#j�Oil 5JJ�9�3.���'�.,COt�E�t'�t�1'�O�7E�7tl��C�l��O/'p�����'�. Port�o�s o�'��
t�re i��ort�ra�o�rn-ay be Glas�i�ed as non pub���t�;�t�prov�de s�ecr�r�c rsas�ot�s tfiat w�#x�perr��t t�r�Ci#jr t�
cc�ncl��le t�aat't�$ �re t�~a�le s�c�r�. �
CALL BEFORE YOU DIG. Call Gopher State One Cafl 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.orp
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 p►ans.
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.
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ApplicanYs Printed Name Appli s Sign ture
Page 1 of 3