4087 Beaver Dam Rd05106/2014 09:40 Les Jones Roofing, Inc. (FAX)9528817009 P.0041011
411111* City of Eaall
3830 Pilot Knob Road
Eagan MN 65122
Phone: (661) 676.6676
Fax: (661) 676-6694
Use BLUE or BLACK Ink
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Permit #: 1 D( '^ 1 i1
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Permit Fee:
Dale Received:
Staff:
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Z//q
Site Address: Lip s rto1 � 'to C3 gal &a.ve2 PAIA `Pop Unit #:
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Name: yo PeOPddit2TY C-4461 I Are... Phone: 457- 3-51/- ?9 ?q
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Address /City / Zip: � BO 21 � 5 /NvE/Z 6/2 -..ora /4� /yit� �� �
Applicant is: Owner x Contractor
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Description of work: IFfri 1 �4jl jl01i�!✓ UO,-
Construction Cost: $ 9fii a?/- *7-.- Multi -Family Building: (Yes x / No . )
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Address: 9v W. 8d S°i" o
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State: /4l4 Zip: frie20 Phone: 95A - id, 1 - a8/9
License #: 63-60 Lead Certificate #: .U4T- Yo 8 9? -/
If the project is exempt
from lead certification, please explain why: (see Page 3 for additional Information)
in the last 12 months,
_Yes _No If
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
COMPLETE THIS AREA ONLY IF CONSTRUCTING AifW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
Phone:
Phone:
Phone:
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CALL BEFORE YOU DIG. CeII Gopher Stats One Call at (661) 464-0002 for protection against underground utility damage. CaII 48 hours
before you Intend to dig to receive locates or underground utilities. yvww.aooherstateoneca0.orq
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 le not to start without a permit; that the work will be In
accordance with the approved pian In the case of work which requires a review and approval of plane.
Exterior work authorized by a building permit Issued In accordance with the Minnesota State Building Code must be completed within 180
days of permit leeuance.
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Applicant's Printed Narne
Applicant's Signature
Page 1 of 3
05/21/2014 10:19 Les Jones Roofing, Inc. (FAX)9528817009 P.009/011
41/11. City of Eatan
3830 Pilot Knob Road
Eagan MN 66122
Phone: (661) 676-5675
Fax: (651) 675-5694
Use BLUE or BLACK Irak
For Office Use
Permit#: I7,? -5111-14
311 :s
Penult Fee:
Date Received:
Staff:
/`�//'Y
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Z/ / e Site Address: '1iZ 5, ' D7 9, 4'O '1Ot7 UnIt #:
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Name: yo Peoet rY GSE, 6Ne.. Phone: 6s/w Ff'1 991/9
/ City / Zip: �P O. BOX 212 5 /N/i�- eve•.o✓Z th /Lit/ . 7 4
Applicant is: Owner Contractor
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Description of work rf 44' Qd7)L+9 - Soma !�Ml71w age,* 6:
Construction Cost:139 �"' Multi -Family Building: (Yes A / No
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Company: SES �ON&3' R�OF<i✓� ,
Address: 9 t I W. 80 "7,ze � City: ,Bco
State: mn% Zip: ,ii.412D Phone: 9S,2 - 76 7 - ag/9
License #: 6,5-60 Lead Certificate #: 4)41^ Leto 3 9? - /
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If the project is exempt
from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
_ Yes No If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
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CALL BEFORE YOU DIG. CeII 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 Mlles. www.gooherstateonecall.Qre
1 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 1 understand this Is not a permit, but only an application for a permit, end work le not to start without a permit; that the work will be In
accordance with the approved plan In the cane of work which required a review and approval of plane.
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.
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Applicant's Printed Name
GEC's
Applicant's Signature
Page 1 of 3