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4637 1_2 Penkwe Way eIT 1F ',MAN r " NATER SliRVICE �' i t► itee4 PeRmIT ®: / s, J is��s _ DATE . .. wII N of knits: 1 . unit tnitse Orrin, Thompson Foes es ;4+ 37 Pen' aE T,/ay 1. 2 B4 J C Ridgy e III Menz �: 3(!S 00 Rd . Asia. - t : • cor cti+ Oterge; 1 Skew Amour* 10.°° gd Pewter Permit Fee- 31 50 pd 11 apse emer 4rINr Ilte City of Sages Surcharge: 60.00 pd meter Mac. oto+9es: Total: eY Dote Paid: Detterf .-.-_— i r�p.: swat S CE PST ite . pMIT Maw, ket 1111 22 r Units: t i . TOrI r�9 Cr—:— t ,car., L2 134 C `.:/7/8e 2041 1 M Dept. '; Permit Fee: Surdxn'ge: Ity Mist. D n , Date of (rR. `' - Total: Dote Paid: i 14 � h � V.,' i 'r t ,-- -.'. „ ' ���31 `�(a��7 � �7- �����j. �(�3� � ��- ' use BLUE or BLACK lnk � For Office Else -------� . �Jy , � �37� , �1�� O��� �Il 4 � Permit# � �� 1 °-� �p ! � � Permft Fee:, J. i 3830 Piiot Knob Road � t Eagan AsN 55122 � Date Received: � Phone:'(651)675-5fi75 � � Fax:(651)675-5694 t Staff: ! � 1 � . . . . . . . . .. . . .. ' � ����������l. 2�14 RESiDENTlAL BUfLDING PERNiiT APPLiCATlt�N qate-�"'�a�`j c� Site Address• �6 3'% _'�l� 3� �lz, ��r Y�.j-� Cv�'`1r unr�#• . � Name:�f?�"t?i�� ���� �t.�:�i}�z��i t_..- �Phone: Residen#t .,� f�iAttl�� Address t City/Zip: l".���✓�°' /E'�j� Appticant is: l3wner � Contractor �ir9y � - �- -- .� TY�e.of 1lVo�'lc ��tion of work: � �t� � � ��� Gonstruction Gast j�'r��0 � N4utti-Famity Su►lding: (Yes ,y /No !:� �..) Company:lV�Y�2���'�9-��"r,�'s �c taa:�.� �`���a� 'C�ntr��tar address:��'!(�r'1 Z�i�.! �� L� � �;t�,:���a'�- .{'���oli� � p ,�� ����'��l� 1 State: Zi : .�3f t Phone: EmaiLt +r►r��Jt3v't,�'�S`7�Gc��J7����7��v — License#_�� �.�� �/ 7�j ��c�'��-. t.�d ce,tifcate#:rV�.�-�..r=>r rlr�3 —I if`the project is exempt from lead cet#ification, please expiain wrhy_{see Page 3 for additionai inforrr�ation) COAAPLETE THlS�EA ONLY!F CONSTRUCTING A�EW BUtLDiAtG In the last 12 mo , the Ci of Ea an issued a ``-r � tY 9 permit for a similar ptan based on a rnaster plan? _Yes _No If yes,date and add f master plan: Ucensed Ptuml�r: Phone: Mechanicat Cont�actor: . 3ewer&Water Cant r: Phonec MC?�`L: ;�and,serpp�r�in�'d_o�u�nents th�t ygu sd�rn�t.ar�e�t�rrsider�ed t�be.�u�fiic irrf4nr�t� F+c��s:of . �. rrfi�rriia��n ma�r�ie c(�ssifiec#as r�c�rl p�blic ff yv`�provicile s�`ecl�s.reas+�ns tha��rou[tff�iermr��i+���ita � � � ' ��� can�lt�+dte fi►a#fir�' ,�r�e tr�de s�et�e�S. � �� � CALL B�FORE YOU D16. Call Gopher St�One Cal!at(651)45A-0002 for protection against undergrour�eitlity damage. Call#8 hours befnre you intend to dig to receive locates of underground utilities: www aonherstateoneca8 ora t i►ereby acknaMedge that this information is canplete and ar,�urate;that the work witl be in eonfomtance with the ord'merrces and codes of#he Gity of Eagan; that i understand this is not a pecmit,but cmly an appficat�n far a t�rn+it, and w�k is r�ot#o start watthcnit a pertni#:that the v+rork+roill be+n w" aceordance whh ihe approved ptan in the case of+n�rk whict►requires a rsview and approvat of pfar�. E�cterior woei�suthor�zsd by a building permit issueE!in aceordancs wlth the Minn�ota Stabe Ming Gode m�t be campleted w�thin 180 ' daYs of t�ermlt issuance. ' '�,c ./' x i! '� G ., , ...-- x " Appl�canf s Prir�ted Name . ant's Signature ;, Page 1 of 3