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