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Use - or BLACK Ink
For Office Use
it, b
City of Ear
E o, t~
Permit Fee L~~ J
3830 Pilot Knob Road
Eagan MN 55122 ; [date Rece`ved: / 3- i 3 '
Phone: (651) 675.5675
Fax: (651) 675-5694 i Staff:
i
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Ze ~j Site Address: 27235-- 37 -39 -ql Wi A3DPAre t y unit
Name:
ti Q Tc hone: t " Z '74p
1~ `
Resident! 1 tin L,34,3 t
Owner Address i City i Zip: Q &n~ aI il F) :Z [4%(11 , _ _AJ
Applicant is: Owner -)~_Contractor
Type of Work Description of work: -~ia C)
Construction Cost: Multi-Family Building: (Yes ~ t No )
Company: 3`tt IT-1- typ Aid U Contact: R ;
i
Contractor Address: ~ ~~-tt lrru 17 r city: CAC3 Aai.
State: ! ~~t.11_ Zip: 2C2_SJ_ Ll Phone: to 1 -2-10 _ ) S
License Ai- C >y :Z I~ 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 Gall at (631) 454-0002 for protection against underground utility damage. Call 48 hours
belle you intend to dig to receive locates of under°*oustd uhhttes
I hereby a-knowledge that this information is complete and accurate that the :.pork will be in conformance with the ordinances and codes of the City of
t agan, thel I undwsland this i% not a peraut, hit only an application for a permit: and work is not to start wrlhout a permit that the work wil. be in
accordance with the approved plan in the case of work which requires a reviel-v 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 1 k; i! C~~i R tiTr.rS x
Applicant's P ted Name Applicant's ignature
days of permit issuance.
X x 0
Applicant's P ted Name Applicant's ignature