1334 Windcrest Ave PIONNIT
` } { k 1
c
I
r ' � a of l
r .
,- stea '8�t€ 1 _�
4
Yx t Y
;� � v r
CITY R " �` Y
',21f99 a " SIT #104.
..: 8693
--
Vi z' e
*ate Ate: 134 . °, at Avenue .I3' "83 Wfndcrt t. rx.
.- LW. >
, ,
i l i
' �
"
.� ; ' Tc ; , o f irmi t ,. Y . 7 .
� 9lgitk � �
Use or BLACK ink
-
t For Office Use
a 9
t f'ermd 33D3
City of Eap
Permit Fee 3_
3830 Pilot Knob Road ! }
Eagan MN 55122 Date Received: awl
Phone: 651 675-5675
Fax: (651) 675-5694 t Staff:
3
20'13 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: 3 3 2 ° 3'f - 1~ ~ 3 IS W I,- b CyeS~C AU. - Unit _
Name:
Resident! --i f) C YcR 'T1:ZC 3tJ 6~° 13ZGs)11-t!-&')hone_ Z. ~ D
Owner Address ; City I Zip: Q- 2 in 1~z f f~a~ MA-) 5-
Applicant is: 4::mer Contractor
Type of Work Description of%vork: Jae--RQoV
Construction Cost. 5-p Multi-Family Building: (Yes ~ t No )
Company: n Ir T)V\0 3 U -H Contact: lh u R,
Contractor Address: -I Z-C y Vail 7" i city: 9 Q AN,
State: N_ Zip:) L~ Phone-
License
Lead Certificate:_ j IT cr, I
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:
NQTE. 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 utdty damage. Call 48 hours
betwu you ,mend to dig to me eive locates of underground utilitie=s
I hereby acknowledge that this informat<on is complete and accurate: that the work will be in conformance with the ordinances and codes of the City of
t agan. Thal 1 unde!stand this is nol a permd, brat only an appLcation for a porrrnt, and work is not to start wilhoui a permil treat the work vulf 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 Minnesota State Building Code must be completed within 180
days of permit issuance.
X 11[1 ? L? (sari [1A 92 1 EAZ a~ X
Applicant's P ted Name Applicant's ignature