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Permit#:
City of Ea ~a~
Permit Fee.
3830 Pilot Knob Road
Eagan MN 55122 ; Date Received: ;
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff: I
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//J'' ` 2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: - Site Address: Unit
Name: Y,711- `171S~ C"101P V710 " Y71'1 rte' lg~ll Phone:
Resident/
Owner Address / City / Zip: Ijedee-
Applicant is: Owner Contractor
Type of Work Description of work:/!
Construction Cost: Multi-Family Building: (Yes / No )
Company: 2 dm Contact: i);;l C
Contractor Address: /✓~r ~~1~ e~ City:
State: N17 Zip: Phone: 671 License U e) 16-7 Lead Certificate
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 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.clopherstateoneGall.org
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 plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
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Applicant's Printed Name Applicant's Signature
Page 1 of 3