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sty 4 Hirta Point L3 U10 RSAieoliffe 111
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m No.c - ►: 305.00 pd
Reader J No.• Permit Fee: I° - _ pd.
5 pd
tilprop 1frOw fliatipty wait Hie Cdr o Surcharge: .
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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
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I Ni'e+ % tearply +Wlb !lair of Regan ConnectFon o*arge 4 = '
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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#:
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���°" ���'��� �� Name:—!, ������� �I r�� Phone:
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Res�de t/
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Owner �' Address/City/Zip:
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� i#�� ����.�;, Applicant is: Owner Contractor
��� # ���:� �:
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�;», �� �.: Description of work: �i��� '�►
� Type�of�Work�;
,� ��� ��., ,�F�� Construction Cost: � ( Q � �' Multi-Family Building: (Yes ( /No )
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�;�'�� Company:__ �-tS i/'l 2iJL� t1Uy� Contact:�� �hrl t i'e °s _
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��Contractor��� Address: /�,�-r� � ��Q����� cit : ✓l�`P �
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_ ��' ; State:� � �3�31 Phone �
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Zip: �"`'�l�-��� / EmaiL•�Oh'�Ip h 6irs��l��lvov'Pl� �° l�
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�• ' 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