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Permit
City of Ea I o d 1
Permit Fee:
I
3830 Pilot Knob Road
Eagan MN 55122 Date Received: GI P
Phone: (651) 675-5675 I ~ I
Fax: (651) 675-5694 i Staff: l.lp
/ 22013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 1.? Site Address: " l ,92 - t l P I l l~ D Unit
Name: Al Phone: [,S
Resident/ + v~ C ~M ►!V' ~`~f "L z
Owner Address/ City/Zip:
Applicant is: Owner Contractor
Type of Work Description of work: Rf, r 40
Construction Cost: 12r Lt 60 Multi-Family Building: (Yes //No
)
Company: Contact: , I cv 3 - -3
e1c (d~ 1- 11
Contractor r~J-1E~l[
Address: 3 U t,J City: `
State: Zip: Phone: d f X77- 777
License Lead Certificate
If the project is a empt from lead certification, please explain why: (see Page 3 for additional information)
.p
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. Portion -of
the information maybe 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.org
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 issuance.
x~CvY,.kiL~ *'ca' Applicant's P ted Name ure
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