1864 Buckley Bay
Use BLUE or BLACK Ink
(7
~ For Office Use i
x l- Permit#: 'ant- I
City of Ea~a~
I Permit Fee: i
3830 Pilot Knob Road )
Eagan MN 55122 Date Received: I
Phone: (651) 675-5675 i i
I Staff:
Fax: (651) 675-5694 ( I
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
p~ Site Address kr Unit
Date: ,
Name:
Phone:
Resident/ Alt 'r
Address/ City/ Zip
Owner
Applicant is: Owner Contractor
s Description of work:
Type of Work P):.^- _
Construction Cost: Multi- FarniiBuilding: Yes tle /No-)
Com P anY, Ci t S fr Jitr t~ P~i'n~'l Contact:
Address 2l~a:.:arl', rE~ r l ; City:
Contractor
- / Phone: / .2
State:tj Zip
Lead Certificate _7 C
License - e r
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
concit/de that they are tracte secrets.
CALL BEFORE YOU DIG. Call Gopher State One Cali at (651) 454-0002 for protection against underground utility damage. Call 48 hours
t
Before you intend 1o dig to rec wh e locates of underground utilities. www.gophym
hereby acknowledge that this information is complete and accurate; that the work wiil 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 130
days of permit issuance.
X x _
Athcant`;; Printed Name a Applicants Sign atui~
Page 1
r ,
0Y
r------------------`-+
For Office. Use I
t I ^oC,~ I
; Permit
City of a
I
I Permit Fee: I
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 ; Staff: I
Fax: (651) 675-5694 I 1
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Late: 5ite Address: - Ci ZcG'''
Tenant: Suite
RESIDENT / OWNER Name: Phone:
Address / City / Zip:
Applicant is: Owner Contractor
TYPE OF WORK Description of work: / 1~- 7a
Construction Cost: Multi-Family Building: (Yes No
J ~
CONTRACTOR Name: e) T/ Z°-~~ Xy,1,k-7 ~C License G= 2 ~ ~
Address:q 21z9a -:Y/ /GG1't7f ~ 7u le
City: - d/.I f?l?/~. a State: Zip: J:~'1'
Phone: 912- t 38"/~
/ `~LuG~,G;-~ Contact Person: /
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Category 1 Minnesota Rules 7672
Energy Code Residential Ventilation Category 1 Worksheet New Energy Code Worksheet
Category Submitted Submitted
(4 submission type) Energy Envelope Calculations Submitted
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:
MOTE Plans and supporting documents that you tibmit are considered to he'public information Portions of
the information may be classified as non-public ii you provide specific reasons that would permit the City to
conclude_that the are trade secrete,
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 i
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
,,ccordance with the approved plan in the case of work which requires a review and approv
x VVIt »
Appl cant's Printed Name Applicants Signature
Pag 3