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1916 Southpointe Ter rF .5. • - a S - "tip" .0.-t �-. 12 rte' I� ! S ra , i 4 ' - •a.. r• • a - • spa °,,,.. —.- ., . .as .' - Use BLUE or BLACK Ink � ForOHlastJs�'---------� I Cit of a �Il � p���� � �`��� ; � � � , ���. � � ���: � 8830 Pllot Knob Road � � Ea{�an MAN 55122 j Dsle Receiv�d: � I l / j Phone:(851)679�8675 I � Fax:(651)6755684 I � � I I ♦....�������������r�...J 2o�a RESIDENTIA� BUILDING P�RnniT AP���caTroN �-l�—ly r4oz,o1�,o�,ott;�o, /� Oate: Sf�eAddrees:14i�,_�wi��?, zo,x�,xY Sau;,�/Po�.JT'E 7�2 Unit�: I �' Name:��o A C 7' /�1�4 n.l�1��1'N E�U T .7"�3 C Phone:7G3 -s'43 �7�� � , Address/City/Zip: �5 d � �e.i4 �-^�2 /�t/ � � �oi.�E.� +ViK�� . . � . /�'�.► .S�y,�h . Applicant Is: Owner �Contractor T �,;� .:..";�' Desarip�ion of wor�t� /�L'�.o✓z, e� Q ���f c E �i d�kJ co YP ���k� ' � � � Cohsbuction Cast��9 �� �" Multi-Family Bullding:(Yes x' I No� , . .., • Company: ��/ ���clt�oR /Y/�i,��. �� Contact �wv�9 1��2R�S ��a�7°� �aaress: �/os C�1 6v� S�. ��y; lhP�.S �`'_. � Sqte: /�� Zip: .S�S`�� 9 Phone: �O�� �6�~ �o z�l3 ' � : �icense#; �e �y/�s I l.�aa certificabe#_ If the project is exempt from lead certiflcatio�, please euplain whj/: (see Page 3 for additional information) �[-�la5 �1..)�¢� �a/Lr PoS, / }y � COMPL�TE THIS AREA ONLY IF CONSYRUCTING A NEW BUILDING In tAe laat�2 months,has the city of�agA�Issued a pennk for a��mflar plan based on a maater p1An? �Yes �No If yes,date and address of masbar plan� I.icensed Plumber. Phone: Mechanical Contrs�ctor: Phone: Sawa��VY�ber Contractor: Phono• NO�':��. �..,. ,... . . �-�. � �.<.. ' ,� � �f. '.1��!�',. �- � . ,. _ ..,�!�4�. ,j�,fa�'. . �� Y�% '�„'4y",- .:?' ;,i;" �i• �'W,il �a•� ,�?�.,A t� �:''.:����1�• "t °S.. CA�,L F.f�FOR�YOU bIG. Call Gophq Sbete pns Call at(661)45�.00pZ for proteclion egalnst underground utlliry demsge_ CeM 48 twurs befare you Intend to dig ta recelv�e lacatee of undetground utililies. �vw. op oherst�teon�q.c,� I hergby acknowledge that Ihis in(pmtation is complate ana sopuratg;Met�he woAc will be in Contomtance with the adinanoes and codes of the Gty ol F�gen; that 1 underbyqnd thig is nol a perntk, bu!oNy an appACBtion for a nermR,and wqrk ie not to stsrt wiThout a pertniN, Ihat thc worfc wiU be In� soeo�dana.w�tn tho approv�d plan In rfte Caso oi work whIG1 nBqU1nES a�evi81N 811d epprpv9l C1 plans. Exbedorworic aulhorf�sd by a building permit iSSUad In a�qrytance wfdl tNe Minnoso0s SEate BUlldl Code must bo oompl6ted witi�in 1$0 deys of pertnK Fssuanr,e, z ��Av�� 'g�R2�s X Applican�'s priM�ad Name Appllaant's SIQna� P�e 1 of 3 TB/Z0 3Jvd 1NI�W 1X� I3g L9Z9�98ZZ9 ZS�ZZ btOZ/ZZ/L0 Use BLUE or BLACK Ink � .-------------- , � Fa or�ce use � � i �r,• f ; Pem,it#: (� � � t,l� �! �� � � � �„�F�: 5 I S� ; � � � � 3830 Pilot Knob Road �''�h� F/� �!"!'�°'� I � � „ � Eagan MN 55122 -�;.� � Date Reoei�red: I Phone:(651)675�',675 � Fax:(651 j 675�5694 � �' I � �.����.����w������.��J 2013 RESIDENTIAL BUILDING PERMIT APPLICATION �.�. /� 9n oy o�,og rc� /� Date: �� Si�Address:iSiy,��;�g, xu,xx,x 5�' Sov7-�Pe�.��~�' .7."�2� Unit#: �. Name:��o f1 C T /y1,q n3�4��rit E v T .�"�C Phone:7�3 -s'9 3 - ��7 0 R:� I G � ` t/�� bv�mer . ' aderess�c�y�z�p: 8 so a ��,a �--�,e Av ,� .� � p o E,..� �rr•�.► .SS"�',�,7 �. APpiicant is: - Ov�mer �Contractor T , �'IdV41�c. Description of work: T£� �F-�= � (Z E- �F — YP�:.. � Construction Cost��� 7��.� Multi-Family Building:(Yes � /No� . .. Company: �E 1 £,��rE.2•��e /�'17i,.s�. �� Corrtact ��av�� �`'��5 Cc�ai�r�::;" add�ss: �os t� 6�� S�. c;ty. �PL S. . s��: �� zp: ssy�9 Phone: (a�z - �b�- �x v3 : � ,. ucer�ss#: �� .�YI�3/ Lead cerdficate#: If the project is exempt from lead certification, please explain why: (see Page 3 for additionai i�ormation) ����s �J�Q� l��,�r Pos. i 5+7 � COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 morrths,has the City of Eagan�susd a pertnit for a similar pi3n based on a master plan? _Yes _No If yes,date and address of master plan: Liceosed Plumber. Phone: Mechanical Contractcr. Phone• Sewer�Water Contractor. Pho�: WO�.��af' " : .. „ . . r t/�e.��%rr�i'oi�:'�.�!��' ' :'+` '. ' .• �'�� �� •,,��. .'�" ,,, •,,.'�.Yrr•� ,���'• ..• .y _• '�',�a`f :a;. ,�,`'� '< a So' �`^' S.i X�SaG �:� �'s..� - t �.�'��j.�r�;.• �ALL BEFOR�YOiI DIG. Ca��Copher state o�Ca�i at(651)dsa�o002 for protedion against underground uduty damage. Cau 48 hours b�Y��d to d'ig co r+eCeive bCates of undencjround uGT�tes. www.002h_erstateonequ.orv I herebY�thet tlus infortnation is oanplete arld a�rate;that the work will be in confomianoe wifh the adinances and codes of ihe Cily of Eagan; that I un�and this is not a Cerrnit.but only an appGc�tion for a pein►it.and work is not to start�a aertnir.that the wcric wiu be in aoee�danc:•w:�►a tM aPP`ovod Wan Ut the cese af woMC whNY7 I��WfCS 8(@ViBVH 8fW 8�(NOV81 OT p18�i5. Exterior work aulhorized by a buildln9 Pennit issued in accordance with tha Minn�Stabe Butic6 Code must be rompieted wid�in 180 days of Permit�u8�. X ��Avi� �J�ILJs X Applicant"s Printed Name APPlicanCa Signaturo Page 1 of S