1311 Crestridge LaneRESIDENT /
OWNER
Name: t7/, ie =--2 (.), i 5 To fr-t %./0 Phone: ' 5-1 .3'./1-1 -18 2 q
Address / City / Zip: 13o 3 GYe s ice, :2 f t G. /-4Z g- -¢i- 53'7 2
Applicant is: Owner ' CContractor 7,9,1, . ( 3i2s /30 nog 13/1 °(l /3
TYPE OF WORK
0,
Description of work: ! -ice' 0 ( t `t k ` i /�
Construction Cost: a ) , 4 P Multi - Family Building: (Yes '& / No )
CONTRACTOR
Company: /V® /(,J -4r C - c) l/c9e s �.�r Contact: • r; /l�li i1c7
Address: g�m �'l Z � "7 z i 6 •t- - A---City: ///16- � 27 c
State: /' Zip: 5 S (I Phone: 6/2 -- g `t_ gs 7 />'
License #: b G ICI Ll7.5 Lead Certificate #:
If the project is exempt
from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
No If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
_Yes
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
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.
City of Eapn
Date:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
Site Address:
Use BLUE or BLACK Ink
r —
For Office Use
Permit*
Permit Fee: ° - 7 ,6
Date Received:
Staff:
Unit #:
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.qopherstateonecall.orq
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.
x fr ' '
Applicant's Printed Name
/'l /Z - 7/._ /Applicant's Signature
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