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4695 Hirta Pt �� a j +E. '. lotting: '0 1. t:llit ° �1'7,Se Div to, •4 Owner C t Ut. Thor ° fan Romer sty 4 Hirta Point L3 U10 RSAieoliffe 111 pio Gertz Rya.A m No.c - ►: 305.00 pd Reader J No.• Permit Fee: I° - _ pd. 5 pd tilprop 1frOw fliatipty wait Hie Cdr o Surcharge: . f lege* S : f} . Q .pd t te7C ; wi6remeee. misc. ch arges: Toros: B Date foaid Date of Insp.: knsp.: `crrY " +t x ct ' PERJNIT 37lr *fi1et Kseb *0 PERMIT f40.: Ea, MN U122 DA'Z'E: Zoning: x Qwn6r_ No. of 13r+its: t Site Address: 6 Mdres t Plumbe I Ni'e+ % tearply +Wlb !lair of Regan ConnectFon o*arge 4 = ' Ordisiallees. A000unt pasit: Permit Fes: l r' _ no T,,= • By Surcharge: 5E ' '=tl � Misc. Charges: Dot* of leup.: C 9 Total: Insp.- . / t . a� 1 Date Poid: , Use BLUE or BLACK Ink r________________� I For Office Use � • I Permit#: � � I I �,� City of �a�a� I Permit Fee: . � � 3830 Pilot Knob Road I I Eagan MN 55122 � Date Received: � Phone: (651)675-5675 I I Fax: (651)675-5694 i Staff: i 2015 RESIDENTIAL BUILDING PERMIT APPLICATION Date: � 1 "' �� Site Address: I ��ff /�`U al(k�'fs�+�'� �6�� y��� �Cr"f`� r Unit#: ,�;. � � �������� ���°" ���'��� �� Name:—!, ������� �I r�� Phone: � ��� � .; Res�de t/ ��� ��'��`� � � �-l�7 I �.l S� ��— a�r�'�t�, Owner �' Address/City/Zip: � � � � i#�� ����.�;, Applicant is: Owner Contractor ��� # ���:� �: ��� : ����� � �;», �� �.: Description of work: �i��� '�► � Type�of�Work�; ,� ��� ��., ,�F�� Construction Cost: � ( Q � �' Multi-Family Building: (Yes ( /No ) "�� � �' � . ��.��.��'� "F `� �° � � y� �;�'�� Company:__ �-tS i/'l 2iJL� t1Uy� Contact:�� �hrl t i'e °s _ � � �� � � ����� '. �� � y ���,� '�. ��Contractor��� Address: /�,�-r� � ��Q����� cit : ✓l�`P � � �� ��� �, � � �� q f _ ��' ; State:� � �3�31 Phone � �� Zip: �"`'�l�-��� / EmaiL•�Oh'�Ip h 6irs��l��lvov'Pl� �° l� -> � �• ' License#: ,r�[}( �b��P� 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 P/ans antl su orfiri tlocui�i�ents�fhaf��ou subm f are cons►dered'tQ be��ub,�rc� fo `��`at�on orrtiQ�ns��o�_ � . . .� PP �ti.,,�'�.zara�,�,,,^7. €�#a�� �k,: ''`� ``,� "=�`��.�� "��.. 2�.,..','„� �r. � �, ��� ; '� '�.'�€ �...a3� _ �t�►e�nfor�mation may be c/�ssc ��d s€aor��p�b�Ir�G rf��yQU p��o�r�a/e sp���c� easo �th� woul erm�t t e�t .`#o ��`.��. ., ��.�4 ���'.�. .: �� - � ' � � �:, � .-S� ��r� R° ,.°'� b �: a� ^ �, � . . �,� .: _ ' . � � . �. �:.�on.clud�that�they.are:xtraale sec�ets�; �.���,, - 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 completed within 180 days of permit issuance. �, x �� ��'�`M x App' nt's Printed Name Appli ign e Page 1 of 3