1948 Grant Alcove
Use BLUE or BLACK Ink
__~--_i-_ e-__-I
1 ~ ' I For Office Use I
Zr j Permit It r I
City of Eann
Permit Fee'
I
3830 Pilot Knob Road t i
Eagan MN 55122 I Date Received:: I
Phone: (651) 675-5675 l I
:
Fax: (651) 675-5694 I Staff;
! I
1~. w..~. ar ..w e ~ e+. w.._ ~ ~ ter.......... J
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Site Address Unit
'l
Date:
{
Name; E 3 ,r Phone: l~
Resident! , . 2) X
AA
Address /City / Zip:
Owner t
Applicant is: Owner Contractor
' Description of work: , f iji L- r' f c a
€ Type of Work , (5 "
~,w_
p y ~
Construction Cost: Multi-Family Building: (Yes / No )
Z./ TJ ,721 C
Company: r~ t'.' z r f rl~rf~✓~fit Contact: Jt ZL r I'~r 1~
lltldrryss. ~~(7DSt~JNl"! r~" ^ t:a r ci c; City:
Contractor
State: y Zip: G Phone: 461
(mss 2 2
License << Lead Certificate#: _YL__ -
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:
t Licensed Plumber: Phone:
Mechanical Contractor: Phone:
i
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
e011clude 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
before you Intend to dig to receive locates of underground utilities. www_g. QPr?+
I hurehy acknowk!dge: 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 tliis 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
c a~ t xnce with thn 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 withill '180
days of permit issuance. F
X_\ X
Applicant's Printed Name Applicant's, Signature 1
Page 1 of 3
i
I ForOffice:Use I
City 0 ~ Permit Eali
n I D I
I Permit Fee: [
3830 Pilot Knob Road
Eagan MN 55122 Date Received: j
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff: I
I I
200 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: 11410 Iq / 4
Tenant: Suite
RESIDENT/ OWNER Name; Phone:
Address / City / Zip:
Applicant is: Owner Contractor
TYPE OF WORK Description of work: I Jc-G~fl -142
Construction Cost: Multi-Family Building: (Yes, /No CONTRACTOR Name:. e) Z--!!5 IVIf CtE License Fes- Zzlz)
Address: ? IG~ SLCI '7 i' . w~ z l If 2YO
City: Aili7je-/l/a,21",~5 State: ft~/ Zip: J. 11,..._
Phone: 1-a12-,381`,`
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
submission type) Energy Envelope Calculations Submitted
In the last 12 months, has 'he 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:
Sender & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be 'public information. Portiohs of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that the are trade secrets.
1 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
approval of plans.
^ccordance with the approved plan in the case of work which requi:77X
x~VV L. VVL1 Applicant's Printed Name Applicant's Signature
Page 1 of 3