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4151 Beaver Dam Rd05/06/2014 09:41 Les Jones Roofing, Inc. (FAX)9528817009 P.0081011 40* City of Eatan 3830 Pliot Knob Road Eagan MN 55122 Phone: (661) 675-5675 Pax: (661) 675-6694 2 5-o vr 2014 RESIDENTIAL BUILDING PERMIT APPLICATION Use BLUE or BLACK Ink For Office Use Penult #: I t 9 Off Permit Fee: (iAg t Dale Received: 5) R1 1 Staff: Date: - 1Y Site Address: Air rt sati,111 �, , r.h;� , ,� y nc%14 I`� /S F. osr.D Unit #: Name: yo P20p42TV colieer t NG. Phone: 667— 575"//- 99'vq Address / City / Zip: P Applicant Is: Owner X Contractor Description of work /e -g4101/' 11/10 � �s�y ppF Construction Cost: r 737- ‘/ Company: Ars 122P /63' R fA/ /414. - Address: 9/i W. 7p m s°i-1 Multi -Family Building: (Yes X / No ) Contact CI,rir s A-,041272-soJ State: kind Zip: ff'12e License #: 45-60 City: ,084Ga -vz 1/ Phone: 9'SR — 76 7 - arp/ 7 Lead Certificate #: ,)A -r `iv 3 9.7 - / 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? _ _Yes _No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor Phone: Sewer & Water Contractor: Phone: CALL BEFORE YOU DIG. Call Gopher State One cell et (651) 464-0002 for protection against underground utility damage. Cel 48 hours before you Intend to dig to receive locates of underground utilities. www.nooheretgteonecd,ora 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 accordance with the approved plan In the case of work which requires a review end 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. x G/f-krs f4nfD672.5VA/ Applicant's Printed Name Applicant's Signature Page 1 of 3 05/21/2014 10:18 Les Jones Roofing, Inc. (FAX)9528817009 P.005/011 11111/11‘ City of Eapli 3830 Pilot Knob Road Eagan MN 65122 Phone: (661) 676-6676 Fax: (661) 675-5694 Use BLUE or BLACK Ink For Office Use Permit #: 122.1 Permit Fee: Data Received: Staff: 2014 RESIDENTIAL BUILDING PERMIT APPLICATION '46 "' Date: /199 V Site Address: Y"I 39,'JI `F3, 't/97� H/S/ aE-AVE72 riM►at— 2 }D Unit ft; 0; ,1 ,,�p `"',/. `, �.y�f'.. "" r .1 `+Y'�e'' 1, '''',1.. -' Name: yp P2aPeW1'Y 4-eEi 6NG.. Phone: 457- 5Sv- 99yq Address / City f Zip: V O- BD k• 212 5 /N 472 67a4:44 4 Aid 6S'3P 74 Applicant Is: Owner X Contractor • 4.'4 ; ,e';oDescription fi" aO$ �' �. At a , „ �;. � l r of work: 1EMoy� A+ND 1R�pLACE 5f2ip Mt / ,AI 9 Construction Cost 4 21j 2:27 r Multi -Family Building: (Yes x / No ) ..,. �f U �Ji..`.Y : '" �:At ' i-' � ' e" out ' gi 1Z ', .60 Ear t, �. r . ;,!,1%,,,, X 'r �' Y ,;,,'' ":' s w0` 'f,,,. '1 ';', �i,; Company: .ht-5iTo4453 itaa/V4- /•vG Contact: Cs//2rs 4,vOensoA/ Address: 9K l W. SO 7I 'XeCr— City: JGORR�t t4!rTzwy State: Nin/ Zip: f,!" '2e Phone: 9S1— 74, 7 - a c?// License #: 657,4 Lead Certificate #: .(/47 `to 5 7R / 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 penult for a similar plan based on a master plan? yes, date and address of master plan: Llceneed Plumber: Mechanical Contractor: Sewer & Water Contractor: Phone: Phone: Phone: ' "WK Y6 Malt C 1 f C Y" Oa' W r In firOtatl w '-ii fh rgnr a`, ho'. °o i.��,tff iT dol Piss p;ub",l! yQL`peor�e` s t'irifi `oQ's ilii ' Ms 'g„i,,1 g (r ,,,,,t,"..:6, -.,AL e � 5',„‘ a . iAYw%�,�i"3...e�s� ``�,!?�OI!Iil�l��i�..i.. � ..�',�'S�Jtl.. ?.�54.• ����l a:d..,�...ro?:,..''i:..;.....,rt"'..,..,�a` /. , •.,.� 1' .', CALL BEFORE YOU DIG. Call Gopher State One Call at (661) 464-0002 for protecUon against underground utility damage. Cell 48 hours before you Intend to dig to receive locates of underground utlllUes. www.aooheratateonecall.ora 1 hereby acknowledge that thle information le complete and accurate; that the work will be In conformance with the ordinances and codee of the City of Eagan; that I understand thle Is not a penult, 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 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 Mlnneeota state Building Code must be completed within 180 days of permit Issuance. x G/fkfs /10ERst7,l/ Applicant's Printed Name Applicant's Signature Pagel of 3