3774 Grey Dove Lane
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Use BLUE or BLACK Ink
For office Use
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Permit 16 ,3` (10
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City of Ea
~ Permit Fee: ~ 1 I ac.5 . D ~J i
3830 Pilot Knob Road t t
I Date Received: 12CI I t-,7 I
Eagan MN 55122 I I
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 l Staff t
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2013 RESIDENTIAL BUILDING PERMIT APPLICATION j,
• - - ~ 3790 7r`'? LAILI-
Date iCT-a~'t3 Site Address: 37L4 3~7,a, 377N 3775, 3')80. 3-)Sy, Unit#:
F----- ---..........e_..o.~ Name: Phone:
Resident/
I Owner i Address /City /Zip:
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Applicant is: Owner Contractor
Description of work: Q
Type of Work i ^
; Construction Cost: d Ol a0z) Multi-Family Building: {Yes / No
Company: ~~~°ta2~~f1 no>fct~ ar,' Contact: d~
I i Address: City
Contractor i z#
State: tyl A ~ Zip: 10"53 -1 Phone:
( License #`f 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:
Licensed Plumber: Phone:
Mechanical Contractor. Phone:
Sewer & Water Contractor: _ Phone:
1 NOTE. Plans and supporting documents that you submit are considered to be public information. Portions of
f the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that rheyare trade secrets
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protectinn aciainst underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. ,
I hereby acknowledge that this information is complete and accurate; that thr, ,r rk 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 pem-tit, stud 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 issuance.
Applicant's Printed Name Applicant's Signature
Page 1 of 3