1876 Deer Hills Tr 10/27/2013 23:46 6127890498 PRIME HOME PAGE 02/03
Use BLUE or BLACK Ink
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For Office Use Permit I O I
My of Eajan I a I
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Permit Fee,
3830 Pilot Knob Road I IQ a8- / 1
Eagan MN 55122 I Date Received: t 1
Phone: (661)676.5676 I I
Fax: (¢51) 676-6694 Staff., I...----------._...___r~ L
2013 RESIDENTIAL BUILDING PERMIT APPLICATION ►v,',C~i
Date: a~ Site Address: l~ 7~ J-lll~ l /i Unit
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Name: Phone:
Address I City / Zip: r
Applicant is: Owner Contractor
Description of work: r c7~
~I` ItIIFj E11l1 Construction Costa _ Multi-Family Building: (Yes gNo
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Company:
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Address: 6 M PelIJ-7-i AV C9, At city: f Y!
State: Zip: Phone: r0799
/ License " ► / + Lead Certificate ! 1
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 morfths, 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:
f~Sewer & Water Contractor: 1 Phone:
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CALL BEFORE YOU DIG. Call Gopher State Ono Call at (651) 45x0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. mM gQpbars!ftonecall.=
I hereby acknowledge that this information Is complete and accurate; that the work will be in conformance with the ordinances and codes of the Clty of
Eagan: that I understand this is not a permit, but only an application for a permit, and work Is not to stan 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 Sulidl g Co ust be completed within 100
days of permit fia~ "Rh D10,
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Applic t' Printed NUwne Applican
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