Loading...
1331 Crestridge LaneC!ty of Eaau 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 Date: Site Address: Unit #: RESIDENT / OWNER TYPE OF WORK CONTRACTOR Applicant's Printed Name 2012 RESIDENTIAL BUILDING PERMIT APPLICATION Name: /11, Address / City / Zip: t 32 7 Applicant is: Owner Description of work: Construction Cost: 61' Company: 461/1„..,-4r Address: g Z 712 :0 -, GJ / G State: A- Ifs— Zip: ; 3 (I License #: g G I f 't 73 t XContractor /y/ /G ?r'�� / 321 / 3 3 / / 33 3 /3 3 )' r g dv/ Phone: 6/2 _. l - g j C7 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 i the information may be classified a nori'- pudic if y ou p toy/de specific reasons c onclude 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.gopherstateonecall.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. c x r r Use BLUE or BLACK Ink For Office Use I /e&0(-7(i _ c' Permit #: 37(1.-75 Permit Fee: Date Received: Staff: Phone: G 5 3 -1 -18 2 9 Multi - Family Building: (Yes k / No ) Contact: r ( Y� l - ;" pp cant's Signatur Gam? 6"9`%` 557 a' Mt .vim' ., formation. Portions of ould permit the City to Page 1 of 3