4151 Arbor Lane 0512312014 11:28 Les Jones Roofing, Inc. TAX)9528817009 P.0131016
Use BLUE or BLACK Ink
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City of Ea ~I]n PermitJY (~~l I r j 1
3630 Pilot Knob Road Permit Fee: 1
Eagan MN 65122 Date Received: I
Phone: (661) 676-6676 I I
Fax: (661) 676-5694 1 Staff. j
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2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: S Z'3 Site Address: 4145- %1- q1 q -y 1 S J 4apa.-L.4wr Unit
Name: O l.*E AIzmas Assoc e-Ar.>w- K hone: b SI - 403- T
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Address / City / Zip: 41,% I14R o Q L-4 wr
Applicant Is: Owner X Contractor
Description of work: 6 40 ✓E .A-rtW &&Ar2 &CC &AkW _
Construction Cost 3 7 r Multi-Family Building: (Yes X / No
J` Company: _ Aks &4,2-3 Bwan/fr; /A-- Contact: GaR4 r A-^JDE72.so~
Address: 9111 W. 2WT _city ,6T22,11
State: d _ Zlp: .?D Phone: 96-P - 76 7 - 07819
* ro License M 4~aQ Lead Certificate M
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 Call at (661) 454.0002 for protection against underground utility damage. Call 46 hours
before you Intend to dig to receive locates of underground ullittles. owvaooharstateonecali.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 and approval of plans.
Exterior work authorized by a building permit Issued in accordance with the Minnesota State Building Code must be completed within 18o
days of permit Issuance,
x C*els 406 0AI
-Applicant's Printed Name Applicant's Signature
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