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Use ~ or BLACK Ink
t For Office Use
t '
E terrr, t/ . City of Eakan t Permit Fee ~ / V_"
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
t 3°I l
Phone: (651) 675-5675 /L,7 1
Fax: (651) 675-5694 l Staff.
L----------------
2013 RESIDENTIAL+ BUILDING PERMIT APPLICATION
Date: I ) Site Address: 3 $ ~-J --a1~ 2d( °'3 tom' i flC'{ 1.~.3v- " Unit
Name: t kU Y Q .ti.3_ Y Js ~ hone: -4~` Z -XqU
Resident/
Owner address i city I Zip: I L FAi~<4&~ jM & S1 34
Applicant Is: Owmer 4 Contractor
Type of Work Description of vrork: - ~ F
Construction Cost: ~3 t Multi-Family Building: (Yes i No )
Company: b V+ 7r-Vv A6 v Contact.
Contractor Address: -1 2-0 Cf o V V- „i 17" i city: 97 A G 801
State: N Zip: [ L~ Phone; in s J to _
License C+ Ell J 7 b g Lead Certificate [-41
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 speck reasons that would permit the City to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One call at (651) 464-0002 for protection against underground util,ty damage- Call 48 hours
before you <mend to dig to receive locates of underground utilities
i hereby ackno%4edge that this inforrriat on is complete and accurate that the work will be in conformance with the ordinances and codes of the City of
t-agan tlml I understand this is not a permit, bal only an apphcalror for a permrl, and work is not to star) withoul a prrmil. that th€r work tit: ho In
accordance with the approved plan in the case of work which regdres a revieal and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 100
clays of permit issuance.
x i~ t4 x 0,0,. Applicant's P led Name Appiicant's;Signature