1854 Michael Point Dr
Use BLUE or BLACK Ink
ti For Office Use I
Permit
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non
,J city of Eav I Permit Fee: >
i i
3830 Pilot Knob Road t I
MN 55122 Date Received:
Eagan
Phone: (651) 675-5675 i I
i i
Fax: (651) 675-5694 Staff:
t t
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
d~ Site Address: °i rJi wT Unit
Date
Phone:
I Name:
Resident/ . 2) AA Pow
Owner ~ Address I City /Zip:
t I. s 3
}
F ( Applicant is: Owner Contractor
Description of work:
Type of Work
Construction Cost: 7~S Multi Family Building: (Yes / No
ar / c
P
ntact: 1 ~1
Company..
J
Address;-_21t?,6>.5""1P 1f12 -5f' A)'' city:
t Contractor i ~ /.2
f i State:. ►M -Zip: S:` /1 Phone:
r r)
License r c._ ' 2 ZY CD Lead Certificate # 7
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?
4 Yes -No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: _ Phone:
you submit are considered to be public information Portions of
NOTE: Plans and supporting documents that
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 prc;tection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities-
I horeby acknuvdedge 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 lh; s 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 w;tli the reproved 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 rompteted within 180
days of permit issuance. f
4faplic~ant's Printed Name Applicants Sigrtnture °z
Page 1 of 3
F.: Eoice Use
City of Ea i ~ Permit
Permit Fee:
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff: I
I 1
2008 RESIDENTIAL BUILDING PERMIT APPLI AT O
Date: Site Address:
Tenant: Suite
RESIDENT / OWNER Name: Phone:
Address / City / Zip:
Applicant is: Owner Contractor
TYPE OF WORK Description of work: ~CjC!-112
Construction Cost:c 2 i Multi-Family Building: (Yes, / No
CONTRACTOR Name:_ 6 ! f Z'- /Vif 1;,7 1e,17 v7Cf~ License
Address: _21Z)0 GGY1? l 2Y~O
City: Ajiliz6wl State: ~'d771r7 Zip: -55,1,3
Phone: !C>1.- 3 ,~0 3 fPZ,-0 Contact Person:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Category 1 Minnesota Rules 7672
Energy Code Residential Ventilation Category'l 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:
NOTE. Plans and suppdrting documents that you submit are considered to' h - 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 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 1
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 approval of plans.
Applicant's Printed Name C Applic is ignature
Page f 3
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