1972 Overland Cir
Use BLUE or BLACK Ink
_....__r.....__....._.,__.-.----
For Office Use i
Permit # I
- I lion
City of Eav I Permit Fee: 0
I
3830 Pilot Knob Road i 3
Eagan MN 55122 j Date Received: 1
Phone: (651) 675-5675 1 I
Fax: (651) 675-5694 l Staff: i
i
w.___...._._J
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
pf Ll Site Address: Unit M
Date /77
Phone:
Name:
Residents
r r br a 21APS4oP 4 _
l z__.~
Owner Address 1 City Zip: -
Applicant is: Owner Contractor
Type of Work ' Description of work: j 4' s -
Construction Cost: 7,S I'Adti-Family Building: (Yes,/,- / No )
Company, "7?,, Contact: )3/
Address LD itt tM 4A) F - , let) City: _k'~~,~
Contractor
State: MtJ Zip Phone:
Lead Certificate
License d )License 2.6 2 Z C/ 0
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
i
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:
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
conciffde that they are trade secrets,
w
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 toce.we locates of underground utilities, www.aooherstate or iecall.ora
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 complotod within 180
days of permit issuance.
x E f ~r _ c✓ X = k v
Applicant's Priritecl Name Applicant's Signature
Page for 3
r
1 ; Ford Ice: Use
f.
City of ECG 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 I
- - - - - - - - - - - - -
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date:_ Site Address:" 19bfr /1/0?1, 1X75 J411y~t'f~%> 1~" '>f
Tenant: Suite
RESIDENT / OWNER Name: Phone:
Address / City / Zip:
Applicant is: Owner Contractor
`HYPE OF WORK Description of work: J1~ e d
Construction Cost: Multi-Family Building: (Yes, / No
r ,
CONTRACTOR Name: License
Address:-2-/z9,0 Yf?~ i' die I 'I 7c
City: /J,-yr7r'-/yn~~~ ~ State: /IIr~/ Zip:
Phone: (<-1/2. 'Contact Person: t`a_
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW SUILDIN
Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672
E-nergy Cade Residential Ventilation Category 1 Worksheet New Energy Code Worksheet
Category Submitted Submitted
submission type) Energy Envelope Calculations Submitted
In the last 'l2 months, has the City of Eagan issued a permit for a similar plan based on a roaster plan's
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
I
Sewer & Water Contractor: Phone:
MOTE: Plans and supporting documents that you submit are considered to he public information Portions of
the information may be classified as norr-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
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/enwitth the approved plan in the case of work which requires a review and approval of plans.
x vv t 1
X
Applicant's Printed Name Applicant's Si nature
Page of 3