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1521 Clemson Dr� City otEap Date: x 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 Applicant's Printed Name x Applic nt's Signature Permit #: Use BLUE or BLACK Ink or Office Use Permit Fee: Date Received: Staff: J 2011 RESIDENTIAL BUILDING PERMIT APPLICATION 91GW/1 -- Site Address: / I r C• l l 'SOh i — ,�s ram � /a - 7 o S 74<310 Name: / h1nla.- tl a !6 )omu Dinh erS Phone: ( Address / City / Zip: 15 /5?-1 67-emSOYl 6 Y" E4,32h ,5 vS2 Unit #: RESIDENT / OWNER TYPE OF WORK Applicant is: Owner. Contractor Description of work: •1 /t €44 d.-t 679 " �� Construction Cost: /679 Multi- Family Building: (Yes / No _ ) CONTRACTOR Company: 3a.1a 1.�•r ( v `` 6 u CJ Contact:tCOLV(1cae.. Address: 410 C.X[� wi4r" City: S''t • `© la vv State: M,V1 Zip: License #: e,eoo/ bso Phone: Lead Certificate #: t*Ir°' 'a.543 1 4 If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) Phone: Phone: Phone: 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: Mechanical Contractor: Sewer & Water Contractor: 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.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. Deo-n/1a_ C J/i cic Page 1 of 3 CITY OF EAGAN WATER SERVICE PERMIT 3795 Pilot Knob Rood 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 07r, S \ � ��- Date Paid: Date of Insp.: 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: 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: 1~l°l A 151° I521~ .15218 C U"kon W Use BLUE or BLACK Ink For Office Use 1 City of Eap I Permit I 3830 Pilot Knob Road ~ Permit Fee: Eagan MN 55122 Date Received: Phone: (651) 675-5675 1 I Fax: (651) 675-5694 1 Staff: - - - - - - - - - - - - - - - - - 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: IL Site Address: 1 l I~ I Y Unit Name: I I I l11 1 ! ~ ~ 1~ 1~ f 'C~ yl ; I I~Phone: ;t w~ I VU' Resident/ ' Owner Address / City / Zip: Ell 2- Applicant is: Owner Contractor Description of work: ld V,~L~ " (A Type of Work Q Construction Cost: V Multi-Family Building: (Yes X / 'No . ) Company: 154 a QicccI yy1 C'_,n d &gied~~ ~n4 ntact: ''J? V Contractor Address: t-h Q r )~L=PIs/0~ PJ(u~ City: , S4 Lock SoZ- State:h 'Z`ip:~~ f° Phone: License #:C~2 v01 U Lead Certificate 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 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.aopherstateonecall.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 1 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. x Ja 2lk. Ih T_Ik~ - oA S x- Applicant's Printed Name App ' is ig ature Page 1 of 3