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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