4647 Ridge Cliffe Dr PERMIT .. r ;-.i' n
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p 60.00 pe meter
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By Date Paid
Date rf i r� Irup.:
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Account Deposit:
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By Misc. Charge&
Data of ` Total:
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3830 P�iof Knob Road ;
Eagan RAN 55122 � Date Receroe�d: j
Phone:(651)675-5675 � �
Fax:(651 j 6T5-5694 1 Staff: t
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2014 RESIDENTIAL BUIL.�31NG PERMIT APPLICATIBN
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Date:�'���'"j� Site Addre.ss: L['��/�'" � �/ 7 �� �iG Ci,r/��` ElnFt#'
� tVame: ��/�i1� �-r�'�� t t�t,.�r��?�+�r� �Phone:
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C1W1��F Address I City f�ip: ���"�' /��� ,
Applicant is: Owner � Gantractor
Description of work: ��r�r �(�� �{ ��- ---J'�o�'/"��
TYt�+a of WoMC �
Cons#ruction Cost:������ Mu�i-Family Building:(Yes�/No�
Company;I VC�I��1°5� �r�Y11�v9�C.�U15 '� Cor�taact t l f� �G�tJ��'
� Go�tra�t�r �daress:�5'��� �✓���`��ja�r- L,%�-y}x /� c;�,:���'� �f�t�l.��
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State_�Zip:� Phone: ` Emai1:��►rn�? t3v'L�_,;'..,..5'T��r�t�J`�✓�v�vv —
trcense#: �J� �.r�S� �'1 7� -_�c. �_�-�.
l.e�aa certif[cate#:!V�.t—.—r�i�1 t9 3 ~-�
It the pro}ect is exempt from lead certi#°�cation, please exptain why: (see Page 3 for addition�it informatian)
CflMPLETE THIS AREA ONLY IF CONSTRUCT'ING A NEW BUILDtNG
)n the last 12 roont , a�the City of Eagan iss�d a�rmit€or a similar plan based on a ma�#er plan7 `
^Yes _No if yes,date and addr master p[an:
Ucensed Plumber: Phone:
Mlechanicai Contractor: ,
Sewer 8 Water Con r; Phone:
�OfE= �a�d syppof#in�'docu�n�nfs fl!rat yc�rt sutimit�r�caasideF�c!f4 L�e publhc in�rrn�#an ��rti�ns of
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trtfQrmatiet�m��rb��la�si�ed&s nart pubiic ifyot�pr+ovid'e.spec�c r�s�trs�lr�t t�r�ittfd{�ei�►rtt:��G��,r#t>
c��rcf�de#tr�=f�ie �r��ad�secc�ts.
CAL�BEFORE YOU D1G. Cait GophrerSta�One Ca8 at(651}454-00pZ#arprotection agai�st undergrounci ut�lity damage. CaA 48 hours
beiore you iRtend to dig to receive locate.s of underground utilities. ww�v.c�opherstateonecait.oru
i hereby acknowledge that this irifarmation is t:ompiete ar�d ac�urate;that the vaork wlit be in t:onfwmance with the ordinan�ar�tl codes of it►e Giry of
Eagan; #hat 1 uadersfand this is not a permit,but only an applic�tron#or a permit, and w�ork is not to start writhcwt a permit;that the work will be in
accordance writh Ute appraved pfan in the rase oi u�rorlc wk►ich requires a review arxt approvat of plans.
Exterior�nrork authairized by a building pemvit issued in acc�dance with the Minnesota State iiding Code must be compieted witt►in 180
days of}�rmit issuance. '
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Applir.anf's P�r�ted Name anY's Signature
Pi�f of 3