4422 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:
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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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� Permit Fee:
3830 Pilot Knob Road � �
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I I
Fax: (651)675-5694 I Staff: I
I �
2015 RESIDENTIAL BUILDING PERMIT APPLICATION
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Date: �� 1 / S/ Site Address: +� � ��{Sl"���-� � �`' S/L
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�� Applicant is: Owner Contractor
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T�3� 4"�11�101"k � Description of work: ��✓�� �
�, � Construction Cost: Multi-Family Building: (Yes /No� � �
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� � Address: JSab �'G�;J�w��n, G�/J I� Sulfz °��j City: , / � � �
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' � License# �C `�d� 7�.3 Lead Certificate#:
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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? �
3
� 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�3T�:P��fiS�f�l�5ilp�7t71���i�Qtl�Cil���1#S�/7r?�,�O�/SW���?�'�'Cf3tJ,�!{�'8t�fi�0 b8 plFb���4I`��#1�7. PQ�tions o�' �
c e �
t�e inf�r�aa�ion r�a�be c�assi�Ed a�rran-p�a�bf���i.��t��ro�de�ec�fc r�a�o�s tfiat�var��ad pErr�#t�re Cl�y t�
cflr�cl�c%���t Z�e are t�a�l�e secref�. � �
CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. Ca1148 hours
before you intend to dig to receive locates of underground utilities. www.cLopherstateonecall.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 S t Building Gode must be completed within 180
days of permit issuance.
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Applicant's Printed Name Appli s Sign ture
Page 1 of 3