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
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Dale Received: 5) R1 1
Staff:
Date: - 1Y Site Address:
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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-
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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.
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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;
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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
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; ,e';oDescription
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of work: 1EMoy� A+ND 1R�pLACE 5f2ip Mt / ,AI 9
Construction Cost 4 21j 2:27 r Multi -Family Building: (Yes x / No
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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:
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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