1880 Deer Hills Tr Use BLUE pr BLACK Ink
, ; , r-----------------�
I For Office Use �
' � Permit#: ��� " �� j
C�"J O� �"�,"`� I Permit Fee: ! �!' `� ` �� �
3830 Pilot Knob Road I I
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I �
Fax: (651)675-5694 I Staff: I
I �
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date���$��� Site Address: �F����S� � �7`�'ll,S �r��( Unit#:
�°� 6�a 3g�-�z3
Name: �bQ- Phone:
Residentl C� �� � t
�W�g� Address/City/Zip:��S� ��� ��R1�F /-w ����
' Applicant is: Owner �Contractor
�. Description of work: �c vo
'�j/�!?e Q�Wc�t'k
m�.� , ',�'� Construction Cost: ���1 Multi-Family Building: (Yes � /No_� �
� "'� �- /
`„ ri ���� Company:�PCr�•"U' ��"`� .�o/��ia�) Contact:
COt1�t'�C�OI' , Address: �� ���� S T City: �C�,/�°� /�'i1/�Gj
/� /' Sg�3
State: Zip:�-S�(�d Phone:���'9Cn�{�S EmaiLL'��/�K�^.'���C.��/,�a�
--�
License#: !X—���73� Lead Certificate#: /U�/�
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:
N07'E:,Rlans.�`rid st�ppartin�alc��ur�ents th�f,�c�u subrr�if are�onsidered to be pubtr�ir�fc�rmatiot�. Portion�a�
the 1i�t�ormat�or�may be.cfas,sified�s r�on-p�abli�i�yau prcrviate sp�c,ifi�reas�nsuthat wvuld�verr�i�t ttr��CF�r tr�
�'� .� ` ��a�onclu�►��r�hat the ���r�tr�d�:sec��ts: '��
' 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. vwuw.popherstateonecall.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 State Building Code must be completed within 180
days of permit issuance.
x L�Cas �0,��!/� X
ApplicanYs Printed Name Ap icanYs Signature
' Page 1 of 3