4150 Arbor Lane 0512312014 11:26 Les Jones Roofing, Inc. I:AX)9528817009 P.0071016
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Permit V
City of Eap I I 7-5
Permit Fee: G 1
3830 Pilot Knob Road I 1
Eagan MN 66122 Date Received:
Phone: (651) 676-5675 I 1
Fax; (651) 676-5694 I Staff; 1
I
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 23 Site Address; Jw4 - 4 tgL-414c -1.tt0 Q_ ~ Unlt
Name: 9o r..e AsteoQS s wc. bV'Ah*%W' hone: ~o Sl- 4 Q S- S S~~'
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Address /city/ Zip: li k ao Amok
Applicant Is: Owner X Contractor
Description of work K 6'at o rv6' .A,VD DGF /~pUC
Construction Cost:.* 3 Multi-Family Building: (Yes x / No 74 i r
Company: AE s .vc. Contact: Cmer s A7yJMS0A/
Address: ! T City: ,II-M,1/
A '
` Stater Zip: ,~OfVZp Phone: 545.E - 76, 7 - 0?8/7
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License Lead Certificate 'V n 3 77
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, data and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sower & Water Contractor: Phone:
CALL BEFORE YOU DIG. Call Gopher State One Cell at (661) 464-0002 for protection against underground utility damage. Call 48 hours
before you Intend to dig to receive locates of underground utilities. www gogherateleonecall.om
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 1 understand this Is not a permit, but only an application for a permit, and work Is not to start without a permit; that ft work will be In
accordance with the approved plan In the case of work which requires a review and approval of plans.
Extorlorwork authorized by a building permit Issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit Issuance.
x Clfi2ld f~lUt7S0~ _ x .
Applicants Printed Name Applicant's Signature
Page 1 of 3
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