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1884 Deer Hills Tr Use BLUE or BLACK Ink r----------------"'� I For Office Use � I ,/ /�, I C� � Permit#: 1 ����t/ U � 1Uy Ol ����11 I Permi F : •�� � t ee 3830 Pilot Knob Road � )����,,�� � Eagan MN 55122 � Date Received:-1TLL"�- I Phone: (651)675-5675 I I Fax: (651)675-5694 I Staff: I I I 2014 RESIDENTIAL BUILDING PERMIT APPLICATIQN Date: a f Site Address: ��8�-�l`� ��� �(� 7� Unit#: Name: ��� �u6 Phone: ��a`3��" �3 R+�5�der�#1 - �HS� ���S'� � �� . Qyy��r � Address/City/Zip: G J' � /�� �D�g � z �,�'i � �� �.': �° „ Applicant is: Owner �Contractor T 6 Of WOI'k ', Description of work: �c �� �p Construction Cost:� Multi-Family Building: (Yes�/No� ' Company: �rPsv,°-e-� /�a.�-c S��`/'�--5 Contact: , Address: �3�/" S/� City: �e�c �r�ir c� �Gil'�t'1C�QI" . .: State: Zip:�"D�Q Phone:6�'9'�/,�8'S� EmaiL ���9,��.Yr�o��,,�,/. P0� ' License#: �����3 a Lead Certificate#: �v/� 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: NOTE:Pl�ns antl sup�ortiny a►�cuments that you submi�are eons�dered#r�be public information. Fort+ons ot' the information:may be classi�etl as�aon-pui�li�';if you�rc��ide specifie reasons that wa�ld permit the Ci�y#a �anclude fha#the are trade�e�refs. ' CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.aopherstateonecall.orq 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 Sta Building Code must be completed within 180 days of permit issuance. x G-�iC'G� d [o�Jd� x Applicant's Printed Name Ap licant's Signature Page 1 of 3