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1107 Kirkwood Dr,-ti I � ( ,.. k No. '*f ` nits' (. 'a ,',1 17. Du p JOSe s '11,2Cr Con, t*uct;xcn, /1,7,7 1{,rr, ;, o Di(Addams: , k la B1 074,1 .,ast III; `idt,'es tern . Techanica? -" 12/1/81_ 22142 100100 pd epee to a with the Cilli, ef e, Conned 425 i„ 0 p , ,' t 1.,. ' �, ---t c Permit°'Nt: N. 101 n) pet \ ,- Surcharge: ` G, C 0 pit 6th,. „., Date Paid: Date: City of Eapll 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 r Use BLUE or BLACK Ink For Office Use Permit #: Permit Fee: Date Received: Staff: 2012 RESIDENTIAL BUILDING PERMIT APPLICATION Site Address: 1/05- ' C 3-7 (Cir ut cfi Unit #: Name: rin/ / (/ GG Phone: Address / City / Zip: / /0-5-, ✓A i ✓a ' Dr) v"e Applicant is: Owner Contractor TYPE OF WORK CONTRACTOR Description of work: Construction Cost: ��GC CC Company: Multi -Family Building: (Yes '/ No ) /G% r—i 4.0Contact: 767— Address: Address: ��- /4//.,5 // State: ////1/ License /N//l_Th Phone: , City: !r7" ./9/e 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: 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 Buildi days of permit issuance. X Applicant's Printed me x Applicant'- %-ignatur ode must be comp#4ted within 180 Page 1 of 3