1974 Overland Cir
Use BLUE or BLACK Ink
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For Office Use
4 irk f j Permit, V v I
City of Eap I Permit Fee: _ I
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3830 Pilot Knob Road I
Eagan MN 55122 l Date Received.
Phone: (651) 675-5675 i
Fax: (651) 675-5694 i Staff:
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2014 RESIDENTIAL BUILDING PERMIT APPLICATION
r Unit
Date. ~S y yr p _ Site Address:
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Name: L r 1; f_ rt' ~r s r r I la _ Phone: -
Residentl f _ 2) t r r , ' S7(. _V~r, - P
Owner Address / City I zip:
Applicant is: Owner _a Contractor
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Type Of Work Description of work:
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Multi-Family Uttiktin es / No )
Construction Cost:
Company: Contact: }31 IL- t'l (r lr(
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I~cic~re55-~1#YF>y~r~~ r> a~'T,-I ")-city: Contractor -
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State:., Zip Phone:
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License / Lead Certificate # 7 i
- -
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:
I Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
m!t are considered to be public information. Portions of
NOTE: Plans and supporting documents that you sub
the information may be classified as non-public if you provide specific reasons that would permit the City to
_cortclude that they are trade secrets. m
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for pm.tection against underground utility damage. Call 46 hours
before you intend to dig to receive locates of underground utilities. www.aoC! r,;i,,•
I hereby aci<rio ledge tiiai 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 ,vith the appTuvod 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.
V~A _
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Applicant`s Printed Name Applicant's Signature
~"-~Peg 1 of 3
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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