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1932 Kyle Way
Use BLUE or BLACK Ink l For Office Use J Permit City of Eap ~ Permit Fee: c I 3830 Pilot Knob Road l Eagan MN 55122 1 Date Received: Phone: (651) 675-5675 l j 1 Staff; Fax: (651) 675-5694 l I 1. 2014 J 2014 RESIDENTIAL BUILDING PERMIT APPLICATION Date 3 Site Address: Unit # r"y °f-~c t~ t , T /t Name:!= f > Phone: r3 Resident/, E: x i Sic r+rc+ l(t,'~ S', Address/ City/ Zip Owner I ~ ! Contractor Applicant is Owner = ~'aC Type of Work Description of work: _t a a Construction Cost: _ Multi-Family Building: (Yes I No ? .7w e VV'' w- Company. ~ > . , . , ~ r '~S f ~'i/ ~rt'f3/✓,}r Y ~c Contact: ) AF L t (r4 rC f wpSH ►MfYz Sr N!'. St . City: Address:2 Contractor t i State:. Zip Phone' ( Z Lead Certificate } 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: N©7" E: 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. www-gg_1 ersttie0m!c;~" I he'reby aciv,owledgo 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. j - ApplicalzYs Printed Name i~i7HcarW~ Signature Page 1 of 3 'Yell 1 For bWAce. Use City o a Permit I I Permit Fee: 3830 Pilot Knob Road I I Eagan MN 55122 Date Received; I Phone: (651) 675-5675 j staff: Fax: (651) 675-5694 200 RESIDE NTIAL BUILDING PERMIT APPLICATION /9,17 M37 Date: l Site Address: 11 r 11`~ f 24132r c'.• j' ItLk rte. i Tenant: Suite I RESIDENT / OWNER Name: Phone: i Address / City / Zip: Applicant is: Owner Contractor TYPE OF WORK Description of world' xey~ i, Construction Cost: E Multi-Family Building: (Yes / No---) / CONTRACTOR Name: ~ L~1 Y>/! j~~Y/ 1'7C'~ License Address: /~~GGYt7rt2z°!'t f z~? ~G~ City: J: ?e~/~.~5 State: //I12t'I Zip: Phone: Contact Person: ~"'7r /W~~ • COMPLETE THIS ARE, ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Category 1 Minnesota Rules 7672 Energy Core Residential Ventilation Category 1 Worksheet New Energy Code Worksheet Category Submitted Submitted submission type) m Energy Envelope Calculations Submitted In the last 'l 2 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 sypporitin,gdocuments that you summit 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 the : aee,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 ' 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 ,ccordanc/Iewith the approved plan in the case of work which requires a review and approval of plans. x v~ App icant's Printed Name Applicant's Signature Page