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'.. :..i ''-; .-. . - , ',4 ( .. , 2,7 A ..,-.-.: L, ,.-,:.....- '' 7, --, , ...: , ...r..,;::::::-2,: ; 77 -. .i i , , .•::::;:4-i , `i, 7. -•:,,.::';'- ':. , ., ,,y.„12,4,.:4-.(,.f...,,:.-•.:,:,.---..,-,- :-,-;.',,,Atx-,',.'\.v, ,, i.;: , .. ,--, ; ,. .:: - : ,-, 7 - _ ,- ;;;44.-,- , t;N:-:-,, , :-.-_ , ,-.. , :;. .,:i., ,..,,-• , - ': '- ' -. alum 41°14 ptivorr 1040.: _ __ ___ f 6 t 12 of -:141100111 , • _ > t Use BLUE or BLACK Ink For office use l Pennrt 0. ~ I ' I P 1 Of Eivan I Pemnt Pea. 1 3830 Pilot Knob Road Eagan MN $5122 i Date Received: Phone: (651) 675$678 I Fax: (661) 676.6684 I I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: -5 --,Z7,4/ ~ a- y; s-41 , s r, (.1 o; b A, t. Y, Site Address:1 Yw., by. 7 0, 7A, 7q, 7 ScurHPe ~a 7`~ .T. 2~ Unit: P Name: c c 19 C T /r1 A,J 4 l0 4 M L s,) , Phone. 743 -.r9i 3 5 7 70 ~ Ovtmer . address I city i zip: 8so kS e~ o+ ~u Q Av ~ ,2 A aotD S•.! vos-t cs-y Applicant is: Owner X_ Contractor TypR+e. f1E c• Description of work: '7'-'.+h2 OP l- (Z E - Qvo ~ onstruc Lion cost 3 1.7 .5. X h . Multi-Family Building: (Yes_ I tJo.~ Company: 1 £a~ r~e.lt~aR N47,i r . [.errZ>D Contact: trav,~ I~v R_R r 5 Address: Yo s- W 6 7 T. City: M p4. $ State. /19a' Zip:.~~'// 9 Phone: ~O x y3 License 0: 4d e- .1 III/ / Lead Certificate If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) ~~Aios I.J~e>r I~,,,cT Pas; i 9~ s' 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? _Yss _No If yes, dots and address of master plan: Licensed Plumber: Phone: Mechanical Contractor Phone: Sewer S Water Contractor: Phone: O t) . Call GaPherst~ Ons Call st (661) 461-0002 for protecWn againA underground udlky damage. C40 48 hours bafm you intend to dig to rtiOelVa locates of underground Lfiftes. ! aoohersts ll or g I h@mby acknowledge that this information Is COmplete and acudrate; th®t the work will be in conform mce with the Ordinances and codes of ttte Ciy of Eagan; that I understand this is not a permit. but surly an appuoadon fa a permk, and Morrk k is not to titeA Ndthout a a00ord®nq with the approves plan in trio ce" or %VDM wttlt:h regWre d rabieW and approval plans, permit: that d w Nark will be in E"0"rior work authoriz8d by a building permit imuod in accordanco with the Mtinnesoia g~ gulldl days or WWI: isetmnce, Code must be completed within 180 aAt,,~ ~~2.R►s appllcanCe Printed Name x Applicant's Signature Page 1 of 3 TO/TO 39Vd 1NIVW 1X3 139 L9Z9T98ZT9 bS:OT bTOZ/LZ/SO • Use BLUE or BLACK Ink I For OfNce Ua�e�y.r-----—� (���} f c� I Pemtit�f •�J� ( U11�� Ol �U � � i �� . 7� � � � Pe Fee• I 3830 Pllot Knob Road E��n MN 66122 j Oate Reaeived: j Phon�:(651)87fi�6676 I � Fax:(6s1)s76�s68a � � � � �----___.�-------__.. 20�3 RESIDENTIAL BUILDING PERM�T APP�ICATION Da�e: S� ,!�/ ,d�sy SG,S"a�,l�, G�., G��/ SFte Address:is�b�,��;'��.�7:t, 7`/�y�. So�rr/iPa�•J 7-� � Unit�: ;J�,:::�.�. N�,e:��o A e r �►�.�a��n� Lv; .7-a e Phone:��3 -s-�� - ���o � , Address/City/Zip: �l S� 1� ��.►4�'—�,2 A✓ �u � ,2 19 �oi,.�E.; (�i�'t�r' , . �,�,� s.��x ti � � Applicant is: Owner �C Contractor � . .,..,. . D�scripdon of worlc: Q E K o✓� a 2 ti-P��c� �Ai�1 e'o TYp�,,�f 1IV!'or�c � Construct;on Cost��9 �� r Multi-Family Building:(Yes�/No�) . .. . .. . ,. " Company; ��.! �,�'r'f_!��o R /1'1?�i.a� �+�--� Corrtact �v4 v� �J f��(�R�5 ����or��.-;. Aadr�ess; �os k� 6�� S>. �;�,. �PGS. , �': _' � State: �� zip: SS'�/� 9 Phone: �O'.; - �C�i- �x 4/3 � .� , Llicenr�e� �� ��/J I 3/ lsad Ca�tificab#: If the project is exempt from lead certification, plesse explain whjr:(see Page 3 for add'Rional iMormation) �L�loS L.��2� �v�Lr Pos: / Q7 �' CpMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW 6UILDIN� �n the last 12 mo��,has the Ctqr af Eagan Issued a permit for a simitar plan bs�sed on a rna�be�pla�n? Yes ".,No If yds,dabB and addnass of master plan: Licansed Plumber: Phone: Mecha�ic81 Contractor. PhOnO• Sew�r&Weter Contractor. Phone• NOT�:.R�al�a�o�d� .. � . ,' K .. , � �. .��'� :-'� . •. +e, ,. ,. . �. � �rJ' • bf@.;� . , • • ••' . ':Y� '� ;�'.K�"��� :,j',"%,.;.,,;� r� �. 1., ,,a.. , � � �Y"�s� �. :�t-� �,i:. 4:A: ,� a •,�f�• +��o.�5r,?ui;:.r�..v� C�.4 B�EQB�Y�U D�• Ca��Gopher Slam One Call et�661)45s.ppp2 fcr protedion aqainsl und�t+ground utlll[y Camege. Call 46�oura Defo�e you�r�end to dlg ro reoeive locetes of underground udlrtJes. �W W.�O]Lh615t8t�OneGgll.om I her�by aGcnowlQdge that this infama6on is oomplele and accurete;thet the work witl be in confamance with the wdinences and codes of the City of Eagdn; tl1aC I under�nd this is npt a p0lmit,but oNy en OppGcetion for a p�►mit.dnd wak i6 noC to start withart a parnut: 1haR the waic will be in aoconea�ee wkh tha approve0 p1511!n tne case W woffc wRICr1 I�DQWr�9 8 18vi@w 8f1Q BpplVVel O(p18n5. Ex�ria'+wwk autho►i�sd by a bullding pBrm7t lssued tn accord��ce wfth tDe Mlnnesota st�e 8ulldln Cods must M complebd wkhln 180 days of psm�ft issupnCe. x ��i�r� ��R2r5 x AppllcanYs Printed Name APPllcanY�SlgnAture Page 1 ot 3 �0/Z0 3Jvd 1NICW 1X� I3S L9Z9T98ZT9 b5�80 bZ9Z/ZZ/90