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2236 Liberty Lanet its - sass, .2 3.2 , aa3t, X�a4bora 44( a4g L` � L 401'City otEaQau 3830 Pilot Knob Road Eagan MN 55122 Phone: (661) 676-0676 Fax: (661) 676-6694 Use BLUE or BLACK Ink For Office Use Permit#: t165491 Permit Fee: a d .is Date Received: I Staff: 71 2013 RESIDENTIAL BUILDING PERMIT APPLICATION a. 3r VAC, t ( / /1!) SiteAddress: �Q 1t� llw y` Co/ r'"`.' �I'tlttit#:iLA i.i;s; ;eisS:;i; : 5:i 4:. .0 i:‘ ,4,;.: 1'1.1 h: ° ,^1e,,:.. .; :, Name; Phone: 2-2.r 'i L /. Jt Aia f Address /City /Zip: Applicant is: Owner ♦ Contractor I IU;d•;;,;ia?il: C!ty of Eaall 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 676-6676 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use Permit #: Permit Fee: I `a dq9 `.IL dO Date Received: Staff. J 2014 RESIDENTIAL BUILDING PERMIT APPLICATION 'D3'3 aay Date: - "i " \ 9 Site Address: _ t V` Unit #: j)a 1 V 8 eside t '. `< owner, :.. Name: mak% I 1A scn gb ...1_ A # Phone: (J''_ `QjJ y U , Address / City /Zip: ire/A. • 1/ ,. 1 i r I A IA o i Applicant is: Owner x Contractor ;o !! ., TYPO Work .. ` Description of work: Ph.: 5 i Construction Cost: II aco I C0 b Multi -Family Building: (-Yes .I / No _) Contra tOr± Company: 3\5 C\lkUt 5 Contact: AfflU lc c Address: 9`- 2) -CL\( Ca+I-'S f . City: S 1 I 'q `) State: \1 1() Zip: q' 1 Phone: ($ (e4 (c Q 9,8J License #: L�--�-4 \1_c1V Lead Certificate #: IUM \ qOa\ J t If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) In the last 12 months, _Yes _No If COMPLETE THIS AREA has the City of Eagan Issued yes, date and address of master ONLY IF CONSTRUCTING A NEW BUILDING a permit for a similar plan based on a master plan? plan: Licensed Plumber: Mechanical Contractor: Sewer & Water Contractor: Phone: Phone: Phone: NOTE: Plans::and su poriln �'documen s...... .... u, . . R :f1.0#.In:9 , .. , , . , ,his �that:you subm/t areco'rrsl�eted Co be pup��c lni�oNrry0tlaill.; ;7oilohs;:af;?;; tbe.inf'ormation may b® classified as nonpublic if yore provide specific reasone'tl at would perrriit the r✓riy tui . '.'1:."':!•.:1..::::::::0:00,4.00;that-tM*y, are_ trade secrets ,.... CALL BEFORE YOU DIG. Call Gopher State Ono 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.aonnersteteonecan.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 1=to Building Code must be completed within 180 days of permit issuance, x Applicant's Printed Name x Applic • ' is Signature Page 1 of 3