Loading...
1328 Windcrest Ave yy 4 � as ' 103 - �.. ,'. :� i ' 8 � �Y�t x s riVb tit i � i a. Y e � y Sf •r -� �" Crry 1 Address: '''All11111 . toy vie *Nifty y am. 413. + k .._ $ E � ate* Floe- 1 Ssevisove • 50Pd ( �r Toebf: i..` Coto ra tr Use or BLACK Ink LL-" # - ForOffirxUse t t City of Eakan ~ t}4?rrnt) .i'? . .I _ v! i } Permit Fee 3830 Pilot Knob Road l Eagan MN 55122 Date Received: ' Phone: (651) 675.5675 1 ; Fax: (651) 675-5694 t Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 2®1 1 Site Address: I 21 - 26 •-Zf3 -3,o VJ %xi De ye, A-w _Unit Name: tl 1V1 ~r '5~~°iJ ~1CLLQhone: " ~{~Z -v4t3 Resident! Owner Address; City; zip: FAKra &..3 Applicant is: 0 ,wrier Contractor Type of Work Description of work: RA aciF Construction Cost: ~f r y Multi-Family Building: (Yes t No } Company: b e lLr+ `fi yr AO U S Contact: uG R.Nppey4na) Address: -l =L-u C + y ni 7V i l r city: EAG AN, Contractor State: Zip: L Phone: (a ` License C 6 8 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: /VOTE: 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 (661) 454-0002 for protection against underground unity damage. Call 40 hours belwe you =mend to dig to feceive locates of underground utilities I hereby acknowledge that this inforrlat-on is complete and accurate: that the work Agll be in conformance with the ordinances and codes of the City of I-a<}an, that I understand this is not a pernut, brat only an appl!catlon for a permtl, and %vork is not to start wilhoul d permit= thal the work wil 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 Onnesota State Building Code must be completed within 180 days of permit issuance. x Z-6-) C-2 A 1 Applicant's Printed Name Applicant's ignature