1517 Clemson Dr€ity of EaQall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: �/ 7 /
o / 2- Site Address: /// 57 S "7 C_ / /•e'n.Oh 6 Unit #:
Name: 1 &m
a-5 (a 162 )Ofrt_f_ 0 (.1.M er S Phone:
Address / City / Zip: /-375/J 7 0e/Ps 61 E-47-1-1 ____ .0...
Applicant is: Owner X. Contractor
Description of work: '� /144 4V- C2.t te µ
Construction Cost: / , 9 c 2 7 Multi - Family Building: (Yes _Z 1 No )
Company:4. )a..1a aco4 6 Rurattlina
c
Address: & �j it c.DysdS+L `
RESIDENT /
OWNER
TYPE OF WORK
CONTRACTOR
State: NW Zip:'
License #: CA C0
Contact: p +vQ NT\cR
For Office Use
Permit #: ' r
Permit Fee: eLS •a
Date Received:
Staff:
City: S't • tfltaaS
Phone: c kS .-S'15`
Lead Certificate #: ' " —I
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:
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 City to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One CaII 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.gonherstateonecall.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.
-44 4' -■ t Ug
Applicants Printed Name Applic Signature
Use BLUE or BLACK Ink
J
Page 1 of 3
CITY OF EAGAN WATER SERVICE PERMIT
3795 Piket Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: No. of Units:
Owner: --
Address:
Site Address:
Plumber:
Meter No.: __ Connection Charge:
Size: Account Deposit:
Reader No.• Permit Fee:
1 agree to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges:
Total:
By /eA` Date Paid:
Do f Ins.: Insp.:
CITY OF EAGAN SEWER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: No. of Units:
Owner: —
Address:
Site Address:
Plumber:
1 agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
By Misc. Charges:
Date of Insp.: Total:
Insp.: Date Paid:
15 5 , 15t5 16, 15 Ll A it
Use BLUE or BLACK Ink
I For Office Use 1
I 11 I
City of Eap j Permit
1 Permit Fee: E _7 I
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I 1
Fax: (651) 675-5694 1 Staff: I
I I
i7 J-T~-------
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address Val V) My t Unit
19
Name: I f' I l 1 t tl 1x1 1~y~~ tlPhone:
l lC S W~ a
Resident/ f ~ r~
Owner Address / City / Zip: J 0 3
0
Applicant is: Owner Contractor
Type of Work Description of work: arv0f
W~Cl(
Construction Cost: ~ Multi-Family Building: (Yes' X / No )
Company: ael0- T1laC~ IyV1 aujc e✓!'IIjEf lrt4'tact: t/A'1?~1M
Contractor Address:__ C/)oD ~>LObs/~r- city: ~S~• Lvt~iS
State: (YI ~k ~ Zip: S~U / (d Phone: -Sod 9/5 79V20
License _oo j U ~6 Lead Certificate / A -r- SG' 3 4
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:
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 City to
conclude that the are trade secrets:
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.gooherstateonecall.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.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of per issuance. _h 1P x 0.12 , Id
T I 1k ~ ~ x
Applicant's Printed Name App ' is ig atud
Page 1 of 3