1936 Kyle Way
Use BLUE or BLACK Ink
For Office Use
I -
Permit I
.:j City of EaEd~ I5 i
Permit Fee: I
I
3830 Pilot Knob Road I , I
Eagan MN 55122 L Date Received: I
Phone: (651) 675-5675 i j
Staff
Fax: (651) 675-5694
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2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: of Site Address: r~ t ft r Unit
Name: Phone:.
r
Resident! 1 G+o tlj ,
Owner Address / City / Zip:
- -w - - ~r~
~eg r ss 3
Applicant is: Owner Contractor
Type of Work Description ofwork:r_~<
x ~ Multi-Family Build
Construction Cost Z ing: (Yes I No )
Company ~ ~!J C," Contact: 13l ~ f ryC
i _
( Address-210CI Sl,tt"Yaf r, dA) Ir 2 J0 city: IS
Contractor E ~i f
State: Y1t Zip: _.S t Phone: / s
License 2 2 2_ 0 Lead Certificate* If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
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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:
:
j 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. Cali 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.aor 1
I hereby anknoWedge 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 unoots-tand 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
acr_.Qrcfan(~e With tine apprpueci 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.
Applicant's Si"~~~ -----~~~"Al +licant's Printed Name ApK 9natur"
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