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1506 Violet Lane Use BLUE or BLACK Ink I For Office Use--------- I I it f j Permit I of Eatan I Permit Fee: L b S a r i I t { 3830 Pilot Knob Road I Date Received: lot 1 Eagan MN 55122 i 1 Phone: (651) 675-6675 i Staff: 15 V 1 Fax: (651) 675-5694 1 2013 RESIDENTIAL BUILDING PErR,MIT APPLICATION /r U le _L dk Gam.- Unit M Date: S _ Site Adder: V n.cs 135° Phone: Ot ~Z' ct O Name: ~ Resident/ Owner Address / City I Zip: Applicant is: Owner Contractor Description of work: e2d Type of Work s Construction Cost: _R 0 Mum-Family Building: {Yes I No -~-~©~-J'j & e Contact L1 a.. t,'~'~`c}- Company: ~ li. City:. yak t ~ ~ w+.~ II Zc~ a S r-=' Address: Contractor _ 177- State:- - Zip: 2 Phone. (D License 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: Phone: Licensed Plumber. Phone Mechanical Contractor' Phone: ~ Sewer 8c Water Contractor r` NOTE: Plans and supporting documents that you submit are considered to be public information, Portions o ' the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that the are trade secretsw CALL BEFORE YOU~DIG. Call Gopher State One Cats at (651) 454-0002 for protection against underground utility damage. Cali 48 hours before you intend to dig to receive locates of underground utilities. www 4ooherstateonecall.ora City 1 hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and odes of the will be of Eagan; that I understand this is riot a permit, but only an application for a permit, and worts is not to start without a permit that the work in accordance with the approved plan in the case of work which requires a review and approval of plans. within 180 F_xterfor work authorized by a building permit issued in accordance with the Minnesota State Budding Code must be compkiled days of permit issuance. X 'L v" _S1\ r 6 R. k+ rcL~ X Applicant's Printed Name Applicants Signature Page 1 of 3