4195 Beaver Dam Rd05/0612014 09:42 Les Jones Roofing, Inc. (FAX)9528817009 P.0111011
411//j6 City of Eta
3830 Pilot Knob Road
Eagan MN 66122
Phone: (661) 676-6676
Fax: (651) 676-6694
Use BLUE or BLACK Ink
For Office Use (�
Permit #: / V I1 R k
Permit Fee: '1_ (40
Date Received. A 3 1
Staff:
2:561/3 "--
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: "2-h,hfl Site Address: Unit#:
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Name: R�'!~1 1V Phone: 5'S�
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Address / City / Zip: Bo. Bok 112. 5 /Pi/67E4E-614 / /L%r' 6' 6'
Applicant is: Owner . Contractor
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Description of work: il�f� /f/UQ �✓G��PLY. /
Construction Cost: 416 �i' /• Multi -Family Building: (Yes X / No __J
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Company: hF5 72'N6 R0I'f?A/6x- Mx- Contact Csl.¢1 s A-,VOQ2s0AJ
Address: 91/ W. gl) Mt .07/ City: IADea1c/A6-TEDi✓
State: MA/ Zip: fs-‘120 Phone: 9.5-A-76. 7 - a8/9
License #: 6.5760 Lead Certificate #: P,4T 'to 3_97_/____
If the project Is exempt from lead certification, please explain why: (see Page 3 for additional information)
In the last 12
Yes
months,
_No If
Contractor:
Contractor:
COMPLETE THIS AREA ONLY IP CONSTRUCTING A NEW BUILDING
has the City of Egan Mewed a permit for a similar plan based on a master plan?
yes, date and address of master plan:
Licensed Plumber:
Mechanical
Sewer & Water
Phone:
Phone:
Phone:
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CALL BEFORE you DIG. Call Gopher State One Call at (661) 464.0002 for protection against underground utlllty damage. Call 48 hours
before you Intend to dig to receive locates of underground utilities. www.aeoherstateonecaliorg
1 hereby acknowledge that this Information Is complete end accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this le 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 required a review and approval of plans.
Exterior work authorized by a building permit Issued In accordance with the Minnesota State Building Code must ba completed within 180
days of permit leeuance.
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Applicant's Printed Name
Applicant's Signature
Page 1 of 3
05/21/2014 10:17 Les Jones Roofing, Inc. ffAX)9528817009 P.002/011
Date:
C!ty of Eap
3630 Pilot Knob Road
Eagan MN 66122
Phone: (651) 675.6676
Fax: (661) 676-5694
Use BLUE or BLACK Ink
For Office Use
Permit#: ' 22,13c
Permit Fee:
Date Received:
Staff:
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
-fir, 44/ Site Address: 1#87,'lr ?/, 4,4/9 5 ,?`/ 49 &-AA/cxt. WA -M 2340 units:
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Name: yo PeoPa2Ty G4?.6 t Ne... Phone: 457- 51-c/- ff'7421'-,
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Address / City / Zip: 10- BOX 212 . //'fl_ ezr--o%d Ali 03-4) 24
Applicant le: Owner X Contractor
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Description of work: R?Mov6 A,wO Rd°P'- 4. 50416- 4441 /44119)S/O/Nlir'
Construction Cost .-4;' A -gi i Multi -Family Building: (Yes X / No
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Company: 4 3 ,ThN53 A wzr- five Contact G/�l�t i �or�so AV
Address: 9'tt w. go"' inzz r- city: to�au ler_J-ae/
State: AV Zip: f$'20 Phone: 9$ - 76 7- X819
License #. 4564 Lead Certificate #: .(.) 7- `t O 3 7 - /
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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,
If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Began issued a permit for a similar plan based on a master plan?
yes, date and address of master plan: "
_Yes _No
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
' %in ftbg h". Otikltkif tig L 0 % -°!dOi'e > QLD/ diff i O; TAIIQf4
' Ute"triffYYi fpnil:etgilActo. bier ,0149 •> (.14,4*,* $ N6volitd e ,titroito
t ill?t 3'4 a1r,tyA ti • g1 g•.,W9.A: 1`dC:.,J.iiuC :%• .„.„,, ?7. •+
CALL BEFORE YOU DIG. Call Gopher State One Cali at (861) 454-0002 for protection against underground utility damage. CaII 48 hours
before you Intend to dig to receive locates of underground utilities. m w.aooherstateonecallsorq
1 hereby acknowledge that thls 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 plan 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 bo completed within 180
days of permit Issuance.
x C/f,2iS 444D6720'0d
Applicant's Printed Name
x
Applicant's Signature
Page 1 of 3