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0512312014 11:27 Les Jones Roofing, Inc. (FAX)9528817009 P.0091016
Use BLUE or BLACK Ink
1 For Office Use I
I I
City of Ea an i Permit#: I Permit Fee: "71- -7 1 15 3830 Pilot Knob Road 1 I
Eagan MN 66122 Date Received:
Phone: (651) 676-6675 1 I
Fax: (651) 676-6694 1 Staff.,
1
I I
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address; N12$' 4130-V/$2-913r1 -Q(3di2 LA.,4C unit
N Name 8 r*,F ,Amseas Assoc. A6Ahw~'hone: SI-4oS-~S~~
Address / Clty / Zip: "11 (o AQ$p p .
i
Applicant is: Owner X Contractor
Description of work: bat d v~ .~AJD /~EOG.Qf.~ BG)r
Construction Cost: 4 3 7 9 7 r Multi-Family Building: (Yes X/ No
ti Company: AE G Contact: CMer s, y-,vaa rLS0A/
Address: 4YI 144 _ Cm,: ~Gdo ~yl ~
State: lAd . Zip: 'V24) Phone: 95A - 76 7 - 011
b ,
License Lead Certificate M _ Wm-
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: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
CALL BEFORE YOU DIG. Call Oopher state One Call at (661) 464-0002 for protection against underground utility damage. Call 48 hours
before you Intend to dig to receive locates of underground utilkles. www.oonharstateonecall.oro
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 pormll Issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit Issuance.
x C*i2rS 4#DiWS0A1 x "17 .
Applicant's Printed Name Applicant's Signature
Page 1 of 3