1219 Timbershore Lane Jul 28 2014 09:47AM HP FaxGates G.C. 7634987710 page 8
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Clt of Ea�an ; Pe�;�Fee: ����� �
3830 Pilot ob Road j ' I
Eagan MN 122 � Dale Received: � �
Phone:(651 675-5675 I , I
Fax:(651}6 b-6694 I S1aff: I
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014 RESIDENTIAL BUILDING PERMIT APPLICATION �
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Dabe: ::.J � Site Address: � �-�� �� � � ,� �.: � ; ��,� •n�s. ° �'=� Unit�:
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Name: ' � �' �., `"� ,�� Phone� ���' �� ` �-:-
� ResidenU
Oyyng� Address I City/Zip: S=° Q��✓�'
�,..__�,. Applicant is:.,..�,..__,_.Owner _�L�...Contractor .,..,................,...,..._..._.,,_ --_-,....,_.
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Type of WOfk Description ot work: ";��' d`�1 /�.'✓��
Construetion Cost: �0, ��• o%� Multi-Family Building: (Yes �� I No�
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Company: �''�c.S ::�GKG�� '�-�-?�-:�a+!' Contact: �i'�t�:�-
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Contracto� Address: =>S� /'r/.;:c=<.�h i1'� city: ;��`'O�T'
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� state: /�'/'�' zip: S✓�;''r,'' Phone: ✓;�L,'�";...'�fS Email: •�`'"'` `�-'`���°s:��/�x.11�� ,w•�:
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License#: �%= ' �° :.3 Lead Certificate#; � '�'�,� � �%�^--:
If the projec!is exe pi from lead certification, please explain why: (see Page 3 for additional irrformation)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
lo the last 12 month ,has the City of Eagan issued a permlt for a similar plan based on a master plan9
_Yes _No It yes,date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contra or: Phone:
Sewer�Water Con actor. Phone:
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NOTE:Plans an supporting documents that you submit are considered to be public Information. Portions of
the informatior� ay be class�ed as non-public if you provide spec�c ieasons fhat would peim�t the City b
_ _..._..__4M conclude that the�are trade secrets. _�_,_�,_�_..___,
CALL BEFORE YQ DIG. Call Gophar StatA One Call at(651)451-0002 for proteclion against underground utility damape. Ca�48 hours
before you+ntend lo dig receive locates of underground uliliGes. www.000herstateonecall.or4
1 hereby acknowledge th t this infortnation is cort�lete and accurate;that the work will be in conformance with the ordinances end codes of the City of
Eagan; that I understan lhis is not a pertnit, Dut only an application for a permil, and worlc is nof to start without a permii; thal the work will be in
accorAance wilh Ihe ap ved plan i�the case ot wortc which requires a review and approval of plans.
Exterior k authoriz by a building pe H issued in accordance with the Minnes e w Code must be complet within 180
d pe It Issuan .
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Appll anCa Printed me ApplicanYs natura
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