1261 Timbershore LaneJul 09 12 10:50a Gates General Contractors
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City of Eakall
3830 Pilot Knob
MN 55122 C/ iV yr aill '
Road
Phone: (651) 675-5675
Fax: (651) 675-5694
7634387710 p.1
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Use BLUE or SLACK Ink
For Mee Use
Permit
Permit Fee:
Date Received:
Staff:
3
a--
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 76 07( Site Address: /Z 5 / • /76 7314644440-4,- 1-1/4/ Unit #: l/
Name: / %A'? oke-444art..1.— Al Phone: G fz° 2 7 f //7a.
RESIDENT/
OWNER ; Address/ City / Zip: 7. d . 60K 2 " , 0 4 /
e e.:41-7 niV PV1 ei./ 5 S - 7 2- /
I.
. . Applicant is: Owner 4 " ---- Contractor
: • • -,..••.. • . .
TYPE OF WORK
Description of work: e 0--/t- /72 c_
Construction Cost: 9' ) 5 0 ?
Multi-Family Building: (Yes
G Company: L., 4 CV esVC4 ,c4r/ezottex5 ontact: . >Aft.4/0- c.---
CONTRACTOR .i Address: !-b V .7 .13 v 11-7 Z-nd 4/ yoo-Scly: , p/ 7 111--* c/Ver l
State: /44."/ Zip: 5 VI Phone: 6 72 -'-' 77- 3 3 yi-
License #: c 7 3 Lead Certificate it:
N r 57 z- 55 /
If the project is exempt from lead certification, please explain why: (see Page 3 for additional infomiation)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the las112 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. iwww.00pherstatepnecall.orp I
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.
X
Applicant's Printed Name
4 i-------
Applicants Signature
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