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2048 Kings Rd J ( ) t p' .�. 109. tT :14.41' ip . t . 8 ''' ' f tl f .,. •�. $ of U nI n �, dupi ``; V '�vesei e; , 111 � �PllfiSf ..Trlri9b .S1 ' Aar dress: t , , d . _ale 3 .i Woo 8 P r; ± art er .1Vo�: connection t e. 450.00 Pd iee: Account Deposit: r, ` tQ_on rod d No ; Pew it Fee: i fires tOCOMnptp°witis the City of Eagan Sur„ . 5Q Pa ncss, . Misc. Charges: 60.00 pd **ter; Total: $y �.. D ate Paid: Date of ` Insp,: !' 'l . � _. �_:,. ., -,--., s'�t f .' ,�z ,l `qua b. y ' .,, mr;^, .LZ�„ t'' .tea •'*�'°' j Y'q ,,k ' ! .. I': } `sh . Address:.. x . 3 > _ n, a , q l 4 : V ein ' iR • 7/ 11 /83 % . } �4 . �, QE1. �EJ p d z 1 e to csm r, wtth tlge City . arde: 423 _ 00 ' 4.i , \ - Perm F G k y L� _ ' Surcharge: _ 50 p d f — Misc. Chorpes: O- Total: de } Dote Pd: c " Use BLUE or BLACK Ink r----------------� � For Office Use � `� / ' �I _��._, I Permit#: U 1�� C��J O� ����� I Permit Fee: �� � 3830 Pilot Knob Road I I Eagan MN 55122 � Date Received: � Phone: (651)675-5675 I I Fax: (651)675-5694 � Staff: � I I 2014 RESIDEN��IAL BUILDING PERMIT APPLICATION '�' ��� �� �� c�,�, /t.t,/�/ S�i Z Z Date:_[��G '" �� Site Addre�: (��� � d� Unit#: 2 Name: �� ` \ � ���(��f�vI Phone: �/Z FS o3 �C �� Resident/ f� 0 Owner Address�City�Zip: c�0���' �i v"1,�S 'C�(x, �p�_�� (�.l C�{ ��� �� Applicant is: Owner � Contractor ' Description of work: � ' ��� � Type of Work Construction Cost: � � Muiti-Fami�y Building: (Yes /No� : Comp • � �C�V�Q ZA �6irt C Y ���-Co . Yl Q'�trlctU� Contractor Address: � ��� City: ��• ��� I State:�Zip: ! � 1 hone: �I `����� Emai: � co n�c�Y' � �na i!. C_a� ` License#: ���"��S Lead Certificate#: If the project is ex 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: Plans and supporting documents that you submit are considered to be public information. `Portions of #he informafion maybe classified as non-public if you provide specific reasons that would permitthe City to - conc/ude'that#he are tradesecrets. 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.qopherstateonecall.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 iss ance. X c� � � ��ti�ui��� X ApplicanY 'nt a y�� ApplicanYs S gnatu � �'�"— � .-+� Page 1 of 3 � � . v� �.���� � �