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
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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
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