1822 Merlot Curve I
From: Parsons Exteriors Inc Fax: (888) 426-9712 To: Fax: +1 (651) 675-5694 Page 13of 26912612013 8:24
Use BLUE or-BLACK ink
1-'-_7 _ - -
;For ii7f[Ice Use
City Pernik of Tap I Pe"It Fe v. 3834 Pilot Knob Road 1 Gl ~ ~ ( 2
Eagan IVIN 55'122 I Date Rt iv~i:
Phone: (651) 675 5673 i. 1
Fax: (651) 675+5694 l staffi; ~
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013 RESIDENTIAL BUILDINGPERMITAPPLICATION.
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datty Site Address: Lin It
1
Resident'
r
Owner Address .1 City l7 Ip Z_ Applicant'rs Owner cont^actor
T)rpe Of Work : piescriptlori ofuumr3c° .s
ConstruclJort Cost GA S Multi-Fr9iFtltly.Bu lding: (Yes 1 Iq0
company. i cc's 11V contact: A:e i a V iy
llddress:' -city
Contractor
License t: Lead ertificate ST3-t
if the project is eX 9Pt frGm lead certification. please explain why. (see page :S for additional information)
!COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEs!lls' BUILDING
In the last 12 months, has the City at Eagan issued a permit fora similar plan based:on a master plan?
yes _N lfyes, date and address of master plat
Ucavised Plumber: Pdton.
Mechanical Contractor;. Phone:
Sewer S Water Contractor: Phone
NOTE: Playas and supporting documents that you subunit are considered to be public information. Portions of
the 1ofarrrtatror t may be ~eJassiJlei~ as non-public if you provide sl~ecilic masons that would permit the City to
. a
~rnclud'~e that they are ode secrets. ~
_v,. .e.._.o.. _ . _.r
CALL BEFORE YOU DIG. Call Gopher State One Cali at (651) 454-0402 for protection against underground utility damage. Call 48 fours
6 esare ~
you intend to dig to receive locates of Underground u15itties. ~A r no~~,ie~ t rnFz_ult.~
1 hereby adviow+,iledge that this informalron is cofnplefe and accurate; thatthewonk Ml lac in tonforrnance with the ordiriarces:and cXjdes of the tatty of
l=agar; that 1 uraders6and this is of a p spit, but only an application for =a perm[; and m>rk is not to start without a ineernil; that the work vnll be in
~ =dance r it 4 the approved plan in the case of worP,'v ich requires a review and-approvi$ of playas.
exter3ar work aulhorizeri by a building permit Issued. in accordance with the t'44trutestata Stale Building corle must be com laced within'laO
days. of permit issuance,
r
X
Applicants Printed Narrme Applicant's ftnature
Page 1. of 3
Use BLUE or BLACK Ink
For Office Use
City
Permit#:Olf Eaaau +., Permit Fee: ! a
3830 Pilot Knob Road i
Eagan MN 55122 APR 13 2017 Date Received: ', -f 3'i 7
Phone:(651)675-5675
Fax:(651)675.5694 Staff:
2017 RESIDENTIAL BUILDING PERMIT APPLICATION
Date:4/SY1 Site Address: 1 i I$'21, ►t29 tty Unit#:
Name: Phone:
Resident/
Owner Address/City/Zip:
Applicant is: Owner Contractor
Type of Work Description of work; 6
Construction Cost: 1 (5"QU Multi-Family Building:(Yes Pc!No )
Company:90150%--) (-vv Scl-A JKV Contact: 3,.iS1,;in S
Contractor Address: 1(01.6 lvr IZtj City: LQ 1 l G�1�
State:r'1'Iv- Zip:Sfo'Z-- Phone: (oft-/91, g9ti) Email: 30cs}-cr,5 e Qc✓'Scc,S1, ca,•�
License#: 1 k3151 K Lead Certificate#: /v fft
If the project is exempt from lead certification, please explain why:
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:
Fire Suppression Contractor: Phone:
NOTE:Plans and supportingdocuments that you submit ere 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.copherstateonecall.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 permiit issuance.
1
x vv)rlh
Applicant's Printed Name
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