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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 .
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1 e to csm r, wtth tlge City . arde: 423 _ 00 ' 4.i ,
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Use BLUE or BLACK Ink
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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
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�'�"— � .-+� Page 1 of 3
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