4079 Cashell Glen 0512312014 11:29 Les Jones Roofing, Inc. (FAX)9528817009 P.016/016
Use BLUE or BLACK Ink
For office use I
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City o EaF Permit
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3830 Pilot Knob Road Permit Fee: "571,75
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Eagan MN 66122 i Date Received:
Phone: (651) 676-6676 I
Fax: (661) 676-6694 i Staff:
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Z3 Site Address: 40 l - 412S CAS ZQ ~ ifOt6~1/
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1 Name• D I µE Atzwga, taoG. ~6Ara~16" K • hone: ~'i ~ 4 S ^ 8 s~~
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Address / City / Zip: `i A4R o R ,
y is
Applicant is: Owner
JX Contractor
Description of work: _ l EN b yE ,A-rV /ship 4W _
v Construction Cost: 13 7 q r Multi-Family Building: (Yes x / No
' Company: AC5 7,o&SX gaW-I * / Iyim. Contact: Cesar s DE+~.so~/
" Address City: '&4e
State: A/ zip: XrV 2D Phone: 9,5';l - 7 7 - a8/9
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i license ( Lead Certificate M If O 3 7 ~ - W47- 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:
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CALL BEFORE YOU DIG. Cab Gopher State One Call at (661) 464-0002 for protection against underground u011ty damage. Call 48 hours
before you Intend to dig to receive locates of underground u0tilles.
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 approvel of puns.
Exterior work authorized by a building permit Issued In accordance with the Minnesota Slate Building Code must be completed within 100
days of permit Issuance.
x G ,ets 4wimsyAl x
Applicant's ~ . _
Printed Name Appllcant's Signature
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