4684 Hirta PtDate:
City of Eaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use
Permit#: /Z'((io'
Permit Fee: ✓ / /- �J
Date Received: # /io/iy
Staff:
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
° 11 SiteAddress:Address: pt e/6FO,(1(fV hit .�- Unit #:
%� VL�3 !t
Resident/
Owner
Type of Work
Name: Ai06CC -1 6- /5.1.
Phone:
��, � N
Address / City / Zip: r'
Applicant is: Owner Contractor
Description of work: 5/ 0/ S
Construction Cost: 51 9- 0 ado • Multi -Family Building: (Yes X / No )
Contractor
Company: )V12 4-41, t i+ Contact: D'il J,elf6Yt
Address: I3?-& 51b2 City: Ovled%SO`le--
State: 1/1111 Zip: SC 3 31 Phone: (0% 2— —i-/— lib 5
License #: a- 03f b 7 Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
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:
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.
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.
x �/1 Cll.
SP6b#1
Applicant's Printed Name
x
Appli s Signa
Page 1 of 3
PERMIT NQ
i MW 122 DATE:
P.II L 1 z:nit
No of Units.
Crri.o Thor- :.;on Tomes
Address:
Site Address: 4634 flirta Point L4 E2 F,idgecl4ffe ISI
Plumber: Genz Pvan
3/8/80 20365 100.00 pd
i sow U. weply 411111 Hoe City of Lege. Connection Ghon.: 9s _ nn i nrt
Ods. Account Deposit:
Permit Fee.: 1f_00 Pd
Surcharge: 5 fl P
Misc. Charges:
Total.
_ �P- Date Paid*
444')
City of Ea�au
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Usej wL
1C (+
Permit#: .1 1 —
Permit Fee: L a� • 5°
Date Received: 1'0 / 013
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 11)/7//7 Site Address: V`7qj9W3Li54p) t/ 8 0.,t%(Y 41rf4 101.,1
Unit #:
Name: Ralie Gl.,, p2 /$'
Phone:
Address / City / Zip:
Applicant is:
Description of work:
Construction Cost:
Owner )4., Contractor
jD `"--`O4'
Multi -Family Building: (Yes / No
Company: 6/2/24P/ //Z4M P , yhJ' , Contact: f! 45-7,7....h, "
Address: /2? City: ( AO:C/4 4
State: 0? Zip: JT3,? 7 Phone: 4/e1- el ‘ — 57:F6'
License #: ?- Iti C 6 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:
Sewer & Water Contractor:
NOTE: Plans and supporting documents that you. submit are considered rto bE
the information maybe classified as non public rf you provide specific reaso
conclude, that they are trade secrets.
Phone:
Phone:
puolic information
s Haat would permit
ons,
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.
Applicant's Printed Name
x
Applicant's Signature
Page 1 of 3