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01/13/2007 16: 50 7633237464 MEP.IT BLDG CO PAGE 11/12
Use BLU�or BLACK Ink
�^For�Pflca ilse w r�———^^——�
o� I
V1U �� �� a� , ��G��� I Permlt#: �oC���T j
� � � PermltFee: ���� �� �
3830 Pilot Knob Road ' ,/�
Eagan MN 95122 �UL 2 �J ZO�� I Dato Receavetl: /'��"f'�'t
Phone:(851)675-5675 1 I
Fax:(651)675-5694 gy;V . I S��. I
L_�__...____-----_---�
.2014 RESID�NTIAL BUILD��VG PERMIT APPLICA,TION
�"�gan
pa�: � 2� �`Site Address: 20'-I 4� �c�c� 'L_n5 O V�p�,�c�, � � r,P un�c�:
� I Nam�:�1�r��-,c�,�taclt..� C CJ A P�one: �5�- Ln�5- �4''4"75
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'� �Y P= _ n�C.9�.tC' f v _ a(Zf� �J512?�
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Applicant Is: �_Owner Contractor
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Description�f work, 1 �n���Q
Constrr.ictfon Cost: � Multi-Family Building:(Yes I No )
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� Company:�P�;-}��,, + y �+���_ , Contact:,��� (�(�y���
Address: 2�J q 3 et7�f1 Q.a p�_��_�C�ity:� G��n��c��
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" ' State��,�Zip:j;�,� � �
I Phone:��0_3��'�� mail:�.�C �rn �..1--�u' (T`�� t
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! �� Llcense#: �Qad Certificate#�:�G ,�,�� 5R-�p�
If the project is exempt from lead certification, please explain why; (see Page 3 for additional in'farmation)
COMPLETE TH15 AREA ONLY IF CO�NSTRUCTING A NEWV BUILDING
In the iast 12 months,has the City o4�dgan issued a permit for a sinn�Plar plan based on a master plan?
�Yes _No If yes,dale and address of master plan: ,,,�
L,icensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer&W�er Cvntractor: phone:
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I� .I��F;�:;.�xr,�i I .y p[ ,1.,,�,�,'-r,,�.?` �^"Y i, I A.•�y�I��• I
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CA_(.L BEFOR�YOU DFG. Call Gopner State One Ca11 at(6S1)454•0002 for proteCfion agalnst underground utlllty tlamage, Call 48 hour�
before you Intend to dig to rec9lve locates of untlergrou�d ut►Il�ies. y�„�w.qophorst�teonec,Rll.o.,[�q
I hereby acknowlodgo that 4his infc,rmakion Is campl�te and accurate;tliat ths worlc wlll be in confoRnance wlth the ordinane�.q�nd codes of the Gty oF
Eagsn;snac i u�eertana cr,�g is nc,t a p�rmlt, but only an eppncation for a permit:, end wprk is not to �t�irt witnout� parmlt that the wortc wfll bE in
aCCOrdance wlth the approved plan in the case of work wNiCf1 requlres a revlew antl Approva�of plans.
ExteMorwCrk authorized by�builqfng pemnit issued�n accpfda�Ce with the Mlnnesota Stdte 6uild"mg Code must be completed within 18a
days af pennk Isxuance.
X�a,u l� �Y]a.u x���,�..�Oo 'YY-i a�u.
Appll�s Printed Name Appllcan s Signature
P2ge 1 of a