3836 Heather DrSA ;
i�►a Roaa
i99 PERMIT`
NNO
5121
DATE: ,
Rit
No. of ,Inns:
4-5,-84 ; 42378 , w 100.08 pd
h► the.City of Elmo. connection Charge: 425.00 pd.
Account Deposit. 15.00 'pd
Permit Fee: 100¢'.pd
Surchorge: .50 pd
!ice o w.
}Total.
cflyofR
3830 Piot Knob Road
Eagan MN 85122
Phone: (651) 6754875
Fax: (651) 6784
•
Use BLUE or BLACK Ink
for office Use
Pool* 1 1 a t
Pamit F
Oete Received:
SurK'
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
/3 sitsAddmso:37..Z.1143y, s%36, 38'Ig
Name; ifo A C r /fr9 Ai* A L m L L T" .7:•) a phone: 74,3�- 3- 9'7 70
Address / City 4'ti`•' �/ i4 God Emil L' 44-1-E4`'
p1 is s!441.7
Applicant is; Owner 2‘.. Contractor
oeb« on of work '7"S.1, Z Ori a• 2 z - (I �
Construction Cost / 3A 7 vo : vt3
Multi -Family Building: (Yes )C 1 No
Company: g L 1 Epr> z'o, !!1(rtzwi C . /4 Contact • •1:1Avr
Ate: Vos 61,1xt, C; mP[. 5 ,
state:/)'!ic! zip: SSV' 9 Phone: 6'A - rbc - (a Z 4,'3
License # 'Q C gill / t.oad Cerdfloats d:
If the Project is woarnpt from Lead certification, please explain why: (sem Page 3 for additional infom ation)
is 4,4 L4Liat- Etozr Post' / 97Ir
,AMY.
COMPLETE THIS AREA ONLY IF CONSTRUCTING A PIEW BUILDING
In the haft 12 menthe. has the City of Caw Issued a pennIt fora similar plan based on a mater plan?
_Yes No If yes, dant and address of master plan:
Licensed Plumber: phone:
Mechanical Contactor:
Sewer A Water Contractor:
CALL Cell eophsrStel a one Call et (051) 454.0002 for pr *eaIon against underemund i4Wty damage. Call 48 hours
before you leo 1 Drs Wats otundo,ipund
thereby acknowledge that this inionnahep IS complete and aconite; that the work WI be in cardamum with tho adnsnoes and codes of Ito Qty of
WM; that l understand atruarderteo with the eitareuen this is nota Pon* but only sn a,.qulr ion fora pennant. and work is not to start tsehout a penult: that the work 41be
planrequire
In
w+ to the arose Owens +mush ° s rs,A.w mina approval ar p.na
atelier work authorized
days of penult issuance.
bye balding norma l:mead In accordance with the Idliawdols Stale BuildCode must be completed within 180
Plane:
•
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6 �a``; t's-='+tyy's c=151 r. �'.�'�.�'y^Tr'• --�
i i'C.+ -�i7!��t#.'�'�Ji11�'N�i",..+4$�-' 'w -� �f-�`af 1' '*� •G,;Loi r
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APPtieatnt'a PrIntIld Nem.
170/b0 39Vd
ApplcsnCs Signature
Page 1 of
1NIt7W 1X3 I3g L9Z9T98ZT9 ZO:bT £TOZ/90/TT
City of Earl
3830 Pilot Knob Road
Eagan MN 66122
Phone: (651) 675.5675
Fax: (651) 676-6694
RECEIVED
MAR 2 a 2014
Use BLUE or BLACK Ink
For Office Uoe aI j (�
Permit a: 1 l3°I `^ 1
Permit Fee:
Date Received: 3
Staff.
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Data; 3-X6Site Address; 34732, 383 CI, 3 34,35235 NSAri/412 isQ
Unit*:
Resident/
Owner
Name: eh) 4. /) 4 6 Z Ix E al•j+ C. Phone: 74 3- S-73, •- g 7 7 0
Address / City / Zip: APS -0 b E C 14•ru 2 4v, A), ,till 60e.640. i.44 -as Y ft )
X7Contractor v'z 7
Applicant is: Owner /\ Contractor
•
.
Type.of�INork..
Description of work: RSA o f., (� a £ PL et -f; 4 d / ..J 6 a Fill c. r rd M L' 7-4 L
Construction Cost / 4 Yat • crO , Multi -Family Building: (Yes, / No __r_)
•
COpitla4or
Company: a£ l & r I c 2 )2 4 i .i' -r . Ce alt Contact ba Lit e as., /LA, S
Address: VP W 4,0*A 17"- City: I)/ PL 5
State: 1.11 Zip: 575'4r// 9 Phone: 10/1- e to / - 62 r/3
License*: 'a C 24/// 3 / Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
t.447S- 13,Jrt,.2- Pos.r /F7r
In the last 12 months,
_Yes _No If
Licensed Plumber:
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:
_ Phone:
Mechanical Contractor
Sewer S Water Contractor:
Phone;
Phone;
NOTE: Mails dna.. •j subl+o t,/� oonq�jr�/ : Cf,
triemfOrmaflof ,.z: 'w)., •.. '
:, clasogf i too k. fi y> , .
CALL, BEFORE YOU DIG. Call Gopher State One CaII 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•g42oherstalconecall.Qrq,
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the Gay of
Eagan; that 1 understand thla is not a permit, but only en application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved pion in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit iriaued In accordance with the Minnesota State Build' Code massa be completed within 180
days of permit issuance.
4 ✓' 124✓2i2.i
Applicant's Printed Name
VO/V0 30 d
Applicant's Signature
7 �G
Page 1 of 3
iNIVW 1X3 I3E LsZ9I983t9 0060 VTOZ/8Z/60