4172 Knob Cir
Use BLUE or BLACK Ink
MEMbb. r _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
I For Office Use 4~ I
Permit 1
City of Eqd I `(d
Permit Fee: I
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received: I
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff:
I I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 9/1/13 Site Address: t4l 7~ ((7Z 17 J~YLO° (""Unit
Name: Ci
Phone:
Resident/
Owner Address/ City/zip: 6
Applicant is: Owner V" Contractor
Type of Work Description of work: P't - 11Q-,&0
Construction Cost: 12) Le 60 Multi-Family Building: (Yes V / No )
Company: Contact: C 3
°cc 10L~
Y'r Contractor Address: ~Cp 3 U City: 1i 7
State: _ Zip: _ t) Phone: 7-q777
License Lead Certificate M
If the project is a empt from lead certification, please explain why: (see Page 3 for additional information)
c~_ ~t i1~4F? ~rj V,\ ,l-av~ it Z2 iN\~ LJ
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
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.,qopherstateonecall.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.
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`l a✓I *App'can' Applicant's R ' ted Name t ure
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