1866 Buckley Bay
Use BLUE or BLACK Ink
f` For Office Use I
a b j Permit i
City of Eap I Te5 S 1
Permit Fee:
I
3830 Pilot Knob Road i
Eagan MN 55122 1 Date Received. i
Phone: (651) 675-5675 1 I
I
Fax: (651)675.5694 i Staff:
I i
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: knit #
t°
L 61)- 41k "t - ~ Phone.
Name
Resident!
Owner Address/ City/ Zip: ) A0 !~4 Al,
Applicant is: Owner 1_ ` Contractor
Description of work:}
Type of Work
Construction Cost: MUlti-Fernily Building: (Yes No
t tts _
Company Contact:
s lrht} i r.,~
Address- 2 l-pe t City:
Contractor
State: Zip: S7 1r/ Phone: -
79 /2-
License ~O 2 Z~ 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:
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
conclude that they are trade secrets.
CALL BEFORE YOU DIG;. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
lwfoie you intend to dig to receiv{.: locates of underground utilities. www.qoyhersWeonecaJI.org
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.
r
Exterior work authorized by a building permit issued in accordance with the Minnesota Stet x, Building Code must be completed within 1~0
days of permit issuance. _Y
µ
Appiic,artts Printed Name Applicant's ignatttre
Page VM-3--
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