4501 Scott TrC!tyofEa�all
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Use
Permit #: /0/ Qe C
Permit Fee: co
Date Received:
Staff:
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: c9nj Site Address: 4107 W/ ' cc ) / ` Unit #:
RESIDENT
Ol�ii► ER
Name: Phone:
Address / City / Zip:
Applicant is: Owner Contractor
P.E OF YI►O K
Description of work: -r-co. r c K Com. Ca — C.
Construction Cost: it o'ty. " Multi -Family Building: (Yes • / No X )
CONTRACTQ
Company: A f G "n q \ r iti\-'RlC oT • (LC Contact: L* I - % 35 7 i l b
Address: Liaise) Nice, cc/. City: 511. Paull N
State: tit t4 Zip: SS 1 1 Phone: & 57- c5//! 6
License #: �6 389'95 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 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:
_No
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:a
Phone:
Phone:
Phone:
NOTE: Plans and sdocuments tt tyrou submit are considered to be public information Portions of
upporting
the information maybe classified s non_ " ubltc f you rola specific `reaso ►s that wouia! rmt the City to
.. conc ude.tha they are Made secrets.tw�
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 State Building Code must be completed within 180
days of permit issuance. ,4� O�Applica s PrinteJi4i7iano1
Name
Applicant's ' ig
Page 1 of 3
C!tyofEaaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Use
Permit #: /(i' /6
Permit Fee: 470. ` (_
Date Received:
Staff:
Q
/ 2011 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: l A 5f I Site Address: LI�1 -tQl LI5O I S604 Tom, I Unit #:
RESIDENT
OWNER
Name: TO t& l V. 4h4' 6Y\ �A6vIie. 1A9( e_ ?A.4<— Phone: / Z— 8O 3- -267
Address / City / Zip:
Applicant is: Owner k Contractor
TYPE OF ....
/� �
Description of work: Fe —rob 1 errf-; /Ae. fwi n GO ii e -
Construction Cost: .t.5 -p _ Multi -Family Building: (Yes 1. / No
Company: 9 t Contact: /27-7 35- % 6 2-0/4)t C.t-"
/ll ieir Prts a-� /
Address: ??0 t o u'tn( A n 011-- City: ry'
State: MN Zip: S 5 3 yo Phone: -/7 403 ` t'i'-!r*7" 3'N q
5c,
License #: 21)&356 6 5 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 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:
_No
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
NOTE Plansana( supporting documents that you submit are considered to be public information.�Portionsof
the information maybe classified as non-public if you provide specific reasons tha` would p it t e° ity to
conclude that they are:tradelecrets
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
days
orized by a building permit issued in accordance with the Minnesota ate Building Code must be completed within 180
Name
Page 1 of 3
St Paul Utilities
��t.t t ies