4689 Ridge Cliffe Dr m 4/9 :i;
gr
. 41T .. ). l un fit mP
O ' iomnson Homes
,
4689 Ridge Cliff e1 'r T,2 153 .3 . Ceke 2� 7, ,
Lenz P,57 art
r Hp : - :enaction : 270.00 net
.br: Ai�rmrnt Deposit•
No.. ts Permit Fare: 1(1 _ no . pri
'. 4Mw1 M the City eF $ Swe�shamps; _ af; p ri
- ''t Mist : - Charges: 60.00 ad eter:
to /9 �r v2bC' Total.
Rote Paid;
pate of insp.: lrnp.;.
.: srry .. owt o sAN sawn .SISIYlt Pangs
$795 !lam WMD Reed PERMIT NO:
MN $5122 DATE:
Zonhj: No. of units: . • °c__ 7 szeti
ckinokr: ( r l e i TI ?' r- 4 c n : c.
Address:
site ,Atddtess: L ( ( 1 if €e 'T' T. %- i .,- f`A. ?, a c ' , f: T
Plumber: E is
1 r
1 wee to goo yr with the City sf isles Connection Charge:
OMdiwwsa. Account Deposit:
Permit Fee: 1 ' , ":'
Surcharge: Y , ) �?
BY Misc. Charges:
Date o(1r . : ;� " / I. O Total:
Insp.: Date Paid:
_
�l� U� . ��� 1 , l �" l � , �(��� ;Use�Lt9E or BLACK!nk
� ForOfficeUBe------- — I
; j Permif#; r���L.� / � I
���� ������� -f� 7 � -Z,` S' I i
�
� Permif�Fee: - ��irJ� { li
3830 Pibt Knob Road
Eagan MN 55122 � Date Receivsd: � '
Phone:(65t)675-5675 � 1 i
Fax;{651)675-5694 i staff: �
�---- ----------+'
2014 RESIDENTIAL BUILDlNG PERMIT APPLfiCAT�ON
oat�: �°'l.2`j`� s�t�Ad�,�s: �b�?> `Tb� I., �2, ��,.� �✓ii�,p,� un�t�:
� tvame: t�C?�1?Y�E-�' Gs�-�� �t;.�r�h�c�. �P�:
Resident/ _ �
QWfl�t � Address i Ci#y/Zip: �����°' �,.ti
'+ APPlicant is Owner z/l. Contractor �
°��Y � �- -' ��
TYpe�f V1/ork ' Description of v�rk: � r1� � � �°�
, � ,
Cans#ructian Cost: 1��G�B Multi-Family'Buildin9:{Yes�/No )
�� / ��- �{ ,'
Company:/VCJYZr1�5� �c��J�t�v9��?�t��5 '� Cor�tact c!r� i�����y
Address:L��Lj�'l ��°�'l�J�/'�7��2- Lr�N�t /� City:l�s ��' ��(�J.s�.
COC!#T8C#OI' �
. .
State:�Zip: ��� Phone:����'�'EmaiL��►r,��$?`?t3r'LV�S'?���d�`�d�#�.�c�r� -
License#:�� �.�� � 7 3 ���_�r�
t ead certiflcate#:rV�-7-�.r-=�/�1 t�3 �-1
If the project is exempt€�om lead certifi+cation, please explain why: (see Rage 3 for additionat informatian)
COMPLETE THiS AREA ONLY tF CONSTRUCTING A NEW BUtLDtNG
�
In t#�e last Z2 mont i , tt�City cf Eagan iss�d a permit for a simitar plan based ort a master plan?
.,,_Yes _Na It yes,date and ad�drL� f master plan:
Ucensed Plumber: Phone:
Mechanica!Contractor.
Sewer 8 Water Gont r: Phane:
1VATE: and sup�ir�rting d+o�ument�fhat ycrr�s�ubmtt are.c�nnsftlered#a�e pvb�rc infcir�#�an 1���r�s t��
- rnf�r�#ra�cm may b��lass��d as non pc►b�c`Ff yo�u provtde spec�G rea�crrrs tfr�#wa�rld�e�nti�`�.C�}r t+�
? �ons�ude th�t�►e "a+?�frade secr+�ts;
GAi.L BEFORE Y�U DIG. Gal!Gapher State One CalF at(651}454-0002 for protection againsf undergrour�utility damage. CaU 48 hours
before you irttend to dig to receive toc�fe.s of underground u#Nities. www.aophe�stateanecalt.org
1 hereby acknowAedge that this is�formation is compiete and accurate;that#he work will be in confortnance with the ordinara:es and cndes of the Gity of
Eagan; #hat I undetstand this is not a permit, buk anly an app4icatron for a peRnii,and wrork is not to start without a�m�it;'that the wodc wilt be in
accordance with Urte appraved ptan in the case of wAOrk which r�quires a r�eview and approvat of ptans.
Extedor work author�zed by a bullding permR issued in accordance with the Minnesota Sf�t,a ilding Gode m�t be compiebed within 180
days of psrmit issuanca.
X �K .��../.�' � . .. ..
� �"l� i'-l X '"
ApplicanYs Printed Name � ant's Sigrtature
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