3781 Red Robin Lane
A 110
Use BLUE or BLACK Ink
For Office Use l
City of Ea Permit#: I
I Permit Fee: -7
3830 Pilot Knob Road I I
1 Date Received: 2 I`~ I
Eagan MN 55122 I -k-- 1
Phone: (651) 675-5675 I
Fax: (651) 675-5694 I Staff.
t_----------------.1
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
its -13
Date; Site Address: 3_7 75 37-2 3 78'1 3785 b;•, ~4'ttUnit*
~
i
Name: Phone;
Resident/ iii
Address / City / Zip:
Owner !
Applicant is: Owner Contractor
,i @ 0 o Description of work: C?ca ` -,D e
Construction Cost: ' 1 5 0 0 Multi-Family Building: (Yes / No
{ Company: ~~~°1o~n~¢\c ~r t~ ftoJuca~-, Contact: 4'- 1 Qf
1
Address: f~
Cantractar 2' ~t a Z)r, City:
;State: M Zip: Phone: J `'1 15 - c~ ?Oro
l
License ~ - )~iP ibq 5 Lead Certificate P7_ - ;10(yo'~ " l
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 fast 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 he public Information. Portions of
i the information may be classified as non-public if you provide specific reasons that would permit the City to
I---- conclude that tare trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Cali 48 hours
before you intend to dig to receive locates of underground utilities.
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 issuancce.?
X J0.r I I7~,c~~*~~' X s-'~if~
Applicant's Printed Name Applicant's Signature
Page 1 of 3
Use BLUE or BLACK Ink
r----------------�
I For Office Use �
I �
' � Permit#: � �
C�t� of �a��� � �
� ,
I Permit Fee: • �
3830 Pilot Knob Road � �
Eagan MN 55122 �ZZECEIVED � Date Received:��"o�� � ',�7^ �
Phone:(651)675-5675 � _1� �
Fax:(651)675-5694 OC 12 3 Z015 I Staff:`"�U i
' __-__-J
2015 RESIDENTIAL BUILDING PERMIT APPLICATION
Date:_�a l 0�01�� Site Address: ��C �� ����r^ �if/ Unit#:
��: Name: °S. ` � ��qc"�i-�- ,` Phone:
� F��eSr(fer�tt 7$ l� Q K- �j�`� �„�/ .r� J�.S�!��
, . '(�y�11E� „"`' Address/City/Zip: � ( � o �1n �,�! a/�
� r
Applicant is: Owner � Contractor
.�.�� ������ ; Description of work: i` j�(G�Ccrti- � f,ol��n a�,,.lS �`µ , %STi'� L��r'�
� � �',: Construction Cost: -/ Multi-Family Building: (Yes /No )
�t: , j � � � 1 � �� �
�,' Company: ��"CGt,�"" hG�.�L'S c.�i�✓L�� 6 �ontact: �f.�YL'�
�t3�1��'���` �.� Address:���g� ��'�tti.arrP_ ,�� City: ��Q_j�Gt.`!'C�/
` State:�Zip: �S I� Phone: 9�o g°I/'3�mail: �Y�. �axUi$�a� c%1!'�u���•CoGvl
� License#: �(��/�+7 Lead Ce�tificate#: lU��'� � D�-�-��'� �'
_��
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: I
�
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
Fire Suppression Contractor: Phone:
NOTE Pt�t���t7z����,1�.�`�#��i����� �'��`#�S�►�rC1�f-��#t!?���' � �' ���1�����t #�!�ar3'�i�r����'
�/'1�ll��flT#iTe��'� �f�t '�"�#�
�;�.
s�� 3��' r
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.qopherstateonecall.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 pe it issuance.
x ;�� x
ApplicanYs Printed Name Applic t' ignature
Page 1 of 3