3755 Robin Lane 09/30/2013 09:55 6513447137 AMANDA HANSON PAGE 01
Use BLUE or BLACK Ink
I
For Office Use
PermitOl I c/~~V
Eatan Permit Fee; ,Sp
i
3830 Pilot Knob Road
Eagan MN 66122 i Date Received:
Phone: (681) 6754676 1 p.~ I
Fax: (661) 6764664 I St0 ]t_Y? I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date:. 3'J 3 Site Address: 3~
Name: Phone:
Address/ City/ Zip: 2(P, ~ (~,.~~<A~ C Wt et-, 21
Applicant Is: Owner Contractor
Description of wok gEeO-65 a
Construction Cost: 42t , 4000100 Multi-Family Building: (Yes -X-1211 No
Company. Ci.STq-UGm a. Contact: F fe,
Address: !Z00 "TWr I g L~Cr1 NG s City: Fi) ~D~1 I A! rCL l
State; l111Zip; 3 I Phone: k I 0% (0b
Llcenss; VGQ3 f Lead Cerdflcate* Kilt, - 11( r)
If the project is exempt from lead certification, please explain why: (see Page 3 for additlonal informaWn)
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:
CALL BEFORE YOU DIG. Call Gopher State One Gall at 1681) 4844002 for protection against underground utility damage. Call 4B hours
before you Intend to dig to receive locates of underground utilities, www-gopherstateonecalLoro
1 hereby acknowledge that this Information is complete and accurate; that the work will be In conformance with the ordinances and. cones of the Gty of
Eagan; that 1 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 suthofFzed by a building permit Issued In accordance wMh the Minnesota State Building Code must be completed within 180
days of pemtit Issuance.
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Ap I canYr Printed Name f pi anri Signature Pape 1 of 3