1591 Clemson Dr unit B
Use BLUE or BLACK Ink
For Office Use 1
j "Permit # - 01 i
City of Eagn I
I Permit Fee:. 44A ov 1
3830 Pilot Knob Road
Eagan MN 55122 Date Received: j
Phone: (651) 675-5675
I I
Fax: (651) 675.5694 I Staff: _ - I
2013 RESIDENTIAL BUILDING (PERMIT APPLICATION #
Date: site Address: l6t~,1 ~ j5_°1)pl acj4 ry t~`#!~L_ ~
~~yy -T- Unit
Name: ~ ~,l i IS- M,[ h , e s__ Phone:
Rosidentl
,Owner Address / City / Zip:
Applicant is: Owner Contractor
Type of+WOrk Description of work: mO e- * ~ _
Construction Cot_Z& 1 5 O p Multi-Family Building: (Yes No--)
Company: _aR ~ _67/7~T UG7'/dam----- Contact: -2 _&2g2 en
Contractor Address: O l " Ii a/')P.i'l Aha, city: Minn, -Aal ZS
State: -tLLt=~ Zip: Phone: 6Zc2L. - ?2-1-5506
License _Sir - 197,092- - Lead Certificate #:2s~ ' f
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:
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 may be classified as non-public if you provide specific reasons that would permit the City to
conclude that the are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Cali at (651) 4540002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. Mm.oonherstateonecali m
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
abeA issuance. 6/
Applicant's Printed Name V Applies s Signature
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