1916 Kyle Way
Use BLUE or BLACK Ink
I-ForOffice Use-------
,1j _ 1 I
b• • j; Permit !fY l
City of Eapfl - s l
I Permit Fee:.. i
3830 Pilot Knob Road I
Eagan MN 55122 I Date Received: i
Phone: (651) 6T5-5675 t 1
1 staff: 1
Fax: (651) 675-5694 l I
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Site Address: Unit
Date
- - -
A2
Name: Phone: - 4j4
Resident/ 1 44
Owner Address / City / Zip: el K f~'
Applicant is: Owner Contractor
Type of Work"
Construction Cost: Multi-Family Building• (Yes No )
i r7"1 t l "1~ s~rJ;?r~'h°?t
I Company: Contact:
~Jc~aS tfr?` 1 ~h♦ ' CI City: l t fi%
i Address r Contractor f yvi N2 State: Zip: Phone: i6p
?-e' 2 Lead Certificate
l License
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
before you intend to dig to receive locates of underground utilities r.~ ac~)Ezer g
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 State Building Code must be completed within 180
days of permit issuance.
m
_ x t_ -
Aplriicant's Printed Name ' Applicant's,Signaturv
Page 1 of 3
Is- 1 f
( Ill(`' X17 C l~'`~ %1, /111- IV
- - - - - - - - - - - - - - - - -
J I ,For Office:Use I
r , o~ I C.(~
It Of E a i Permit
I
RdI
I Permit Fee:
3830 Pilot: Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I I
Pax: (651) 675-5694 I Staff: I
I
2008 RESIDENT L IL ING PE T APPLICATION
19,1q rs/7
Date: J" w 7 Site Address: 171" 26
I
Tenant: Suite
RESIDENT / OWNER Name: Phone:
Address / City / Zip:
Applicant is: Owner Contractor
TYPE OF WORK Description of work: -19
Construction Cost: Multi-Family Building: (Yes, / No
CONTRACTOR Name: 17 l e-. 1Vjf /,V7 1' e17zt,7C6! License
Address:
J4-2 r/
City:
State: l / Zip:
v
Phone: I
u ~aGl~ Contact Person i
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Category 1 Minnesota Rules 7672
Energy Code 9 Residential Ventilation Category 1 Worksheet Kew Energy Code Worksheet
Category Submitted Submitted
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:
i NOTE:* Plans and supporting d6cuMbnts than yoer submit are considered to bp_'puhlic inforfilation. Portions 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.
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
:accordance with the approved plan in the case of work which requires a review and approval of pi
Applicant's Printed Name Applicant's Signature
Page 1 of 3