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CityofEa�ali
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office USG I
123-31
l
Permit #: 1
J 1
Permit Fee: 3.631.
Date Received:
Staff:
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
: b "' / -- / c1 Site Address: 415 3 `7 g ;175k k _-), 404 Unit #:
Resident/
Owner
Name: C -11 1/7C— !t;1.4-, '7f—frf
Phone:
Address / City / Zip: 7 ✓C"
Applicant is: Owner Contractor
escription of work:-rc,v0'
Construction Cost 1 ez G QP Multi -Family Building: (Yes X. / No )
Company: A/01'W 5 7-- G OA 7;11+6ir1%�l5 Corrtact tf /y%G 1.-104/
Address:F 61 Z 11 / 7 14-p AV City: > '' 6A 0
State: r?-/A/Zip: i�5 3' Phone: (I' 4/ _ Email: e J inlet) 'erg L 5.7 -ccY1 vrrierel'
License #: ' C 151 L 73 Lead Certificate #: N ,- r=1/ / 1 ,' 3— l
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
the City of Eagan issued a permit for a similar plan based on a master plan'
Yes _No If yes, date and add
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Cont
f master plan:
r. Phone
NOTE and supporiirr documents that you submit are considered to be public infiarmsfion ;Porti+ ns of
tion maty be class fieri as non- public if you provide sPecitk reasons that would a rrtit the Citi tt ,'
conclude that they are trade secrets.
CALL BEFORE YOU DIG. CaII Gopher State One Call at 454-0002 for protection against underground utility da
before you intend to dig to receive locates of underground utilities. www.000herstateonecall.oro
1 hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that 1 understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will 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 tiding Code must be completed within 180
days of permit issuance.
xi/�
Applicant's Printed Name
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Date: V
Use BLUE or BLACK Ink
For Office Use
Permit #:
/23131
Permit Fee:
d3
Date Received:
Staff:
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
-1 41 Site Address: 44 5 3 " `7 44 / ` ''/25k ‘44 Unit#:
Resident!
Owner
Type of Wpb
Contracto
Name: LI() #4,7 �r� tv.�} ? rcfrfelPhone:
Address / City / Zip: e9✓t'
Applicant is: Owner A Contractor
Description of work: ft (41c a
Construction Cost (6, i' 0
Multi -Family' Building: (Yes X / No )
Company:A/OP-411 5 (o'-1-0/5 ' Contact: /7; ; r ir%e" r. o''
Address:Ft46 Z141//1-,67)4.4- 14-y9 A," City: /40,4710)-(-- 61Z 01-/r----
<
i/ .
State //Zip 553' i Phone: (9/`" -Email: 1 m&4z3Y`W6,5'7-Cc50 1- 4e.,
License #: i fel { 7 3 Lead Certificate #: 1V�. t",-- /= J! 1/0 3 ->
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 mon the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes No if yes, date and adds f master plan:
Licensed Plumber Phone:
Mechanical Contractor
Sewer & Water Cont
. s
rormstlon' mai
r: Phone:
om
m
becla
Hca
as
its that you submit are dered public infor
non-pu ilic if you provide specconsiific mato sonsbe that t oui
onclude that they are trade secrets.
ionS
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. CaII 48 hours
before you intend to dig to receive locates of underground utilities. www: gooherstateonecall.orq
I hereby acknowledge that this information is complete and accurate, that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit;that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plan.
Exterior work authorized by a building permit issued in accordance with the Minnesota State = itding Code must be completed w
days of permit issuance.
xi/}
Applicant's Printed Name