3862 Heather Dr3862 Heather Dri.,vcaormectiotl ala
6000 pd matat)V
' S! AGAN
nob Road
P. U 1199
.+.. 55121
7/29/8 373
whip s C$} it `ZtConnection Charge:
Account Deposit:
Permit Fee 1(1 ftin r
Surcharge: , 50 p4
Misc. Charges:
Total:
100.00 pd
475 00 pd
1yofE
3830 Pilot Knob Road
Eagan MN 38122
Phone: (661)678-6676
Fax: (651)6768694
Use BLUE or BLACK Ink
Por Moe Ube
pangs: 118713 --
%mit,e Q73.0 -
C,ete Received: I I /0/0
Stab:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
bre Data: Ao r,' 6 / 3 Site Address: 3 2a G. , 3 �lP
� , 3 8� o , 'SSW /'��`�¢ TN e �Z unite:
a
Name: tVo A G 7- m,4 l4 ro. /11 L) : .�� C Phone: 7443 - Srr 3 - Q 770
Address / City /zip: 15b G +ar�Q Av 43 ' ' .2 iq 6o21E..1 Voitu4d
ArA.t sr
-4017
Applicant is: Owner - Contractor
•
Description of work TFC oP/ I~ ( - krwF
Construction Cost ,, La . c Multi -Family Building: (Yes / No
Company: E) £aC rx,z#o,e 01417.")T. &RA Contact 'DlA '1RR r S
Address: 901.3 601x . City /1/PL $ ,
Starts: Alwi zip; S'S"S+/ 9 Phone: l''z - rb i - !a A S/3
License t rl/l / 3 / Lead emanate #:
if the project is exempt from lead cerdfc adon, please explain why: (see Page 3 for additional information)
rilc.6/ps E./ZEAL/tr. POS. /
COMPLETE THIS AREA ONLY IF CONSTRUCTING ANEW BUILDING
In the teat 12 months, has the City of Eagan lowed a permit for a similar plan based on a master plan?
Yes _No If yes, date and sddraas of master plan:
Licensed Plumber. Phone:
Mechanical Contractor Phone:
Sower & Water Contractee
NO1if ;
Y
Phone:
'.}7Ati►T:'rL'��► '�. l., (. JM..
0 Ys ��L�.�.�.[r.���iL = �i ..Cr��.iJh. �'1'1. _
' .
;N M�;�• �:. .Ti""NY; `�'M t.A.w ,".*T4.'a13F?;,.*921' N 1 h.. :y .7- R Arra-
��v Gopher state Ons VYN et (6 111) 4Y4YWL M • eggnog undergne ..- Welty age. Cal 48 hours
before youokimrlmltd to to 1638 Ion of underground udibee. rrww ss r>erlau-ear
1 hefebY acknaMedge that this informs of I8 complete and =UMW tette work will be in conformance vMth Inc ordinances and codes or the Airy of
Eagan; that 1 understand thi8 is not a pemUt, but My an application for a permt, and work is not to stats without a Pam* that dhe *elk w 1 be in
accordance wan tea approved plan in vne ewe W wore whish requiem a revlow and approval or plan&
E>darior work euthericed by a building permit Issues In accedence with the Minnesota Stat) Midi Code must be completed within 150
days of permit issuance.
X bAkii4 '_uR2• rs
Applicant's Printed Name
UO/TO 39 d
x
Applicant's Signature
79A
Pape 1 0E3
INIt7W 4X3 I3$ L9Z9I98ZI9 ZO:bT ETOZ/90/TT
*City of Eatu
3830 pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax (651) 675.5694
RECEIVED
MAR 2 8 2014
r
Use BLUE or BLACK Ink
For Mee line ++ �L
1 3 4 J '
Permit a:
Permit Fee: LY I ()°
Date Received:
Staff:
31(If
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
d
Date; 3 -.1.1?-/V Site Address: iii•', 31r , 31i'6U, 386x- I/4"Aril d2 QR. Unit I:
ReSldentl
Owner
Name: ek Ale i ft)l.S 4 6 E Na Z A+ mss: •.+ C. Phone: 761 - S S 3- 9 7
7 0
Address / City / Zip: gSO 6 E C 03 -7-1.) 2 Av, A), .Z A 60th f:.. 14444€ Y /OA)
SS -VI 7
Applicant is: Owner Contractor
'
TypS.d.:Work,
Description of work: Rs...., t= a, kg pi., 4-c fr ,i, 4, .J 6 a F-,,rs c. r a NJ x rig L
—
Construction Cost / /' Yd- • CFO Multi -Family Building: (Yes )C / No __)
Contractor
Company: a £ I Ex- r Lei 0 /2 1.44-1-`f . Co 2P. Contact 6";1111 n 6 a d /[ A.' S
Address: lig"-3- L) 10003' ST, City: /17 PL S
State: /ild"- Zip: 5-5-4// 9 Phone: &/ Z - 8 % /-- e.0 Z'/ 3
License #: q E 2 4/./ / 3 / Lead Certificate #:
If the project is exempt
ill -U..5-
from lead certification, please explain why: (see Page 3 for additional information)
Q•./Ly- Pest i5'7Y
In the last 12 months,
_Yes 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:
Licenced Plumber: Phone:
Mechanical Contractor:
Sewer & Water Contractor:
Phone;
Phone:
NATE: OAA ,d00W*. = s .y c
r % i i .• �' � j�i�', �/111„'TT`' i::� :Y; v •,.} � J - h•-',�...•
N !'infer �t7n''- a +b c el as flop ! ��J�bll �/p�� ' . j :,, /i•
,�,,yy����'''' �` ,,����1yr��r.1 �y� 7 q. , � V,, .,. win ;'.. �.
- - ' �f:1il:&..gM'V�'�ra{'/V �➢V474 _ t' : ,•• ..a .Y :'. ,;;k�'
ti
a:4:
&"1.•.''
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CALL BEFORE YOU OIG. Call Gopher State One Call at (851) 4544)002 for protection against underground utility damage. CaII 48 hours
before you intend to dig to receive locates of underground utilities. www.00nherstateonacall.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 1 understand this Is not a permit, but only an application for o permit, and work is not to start without a permit: that the Nark will be in
accordance with the approved plan in the lose of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State BulldlnjCode must be completed within 160
days of permit Issuance.
x ��✓' D �d�2�.15
Applicant's Printed Name
b0/EO 39Cd
Applicant's Signature
-75%
Page 1 of 3
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