Loading...
1219 Timbershore Lane Jul 28 2014 09:47AM HP FaxGates G.C. 7634987710 page 8 I � Use BLUE or BLACK Ink �-----------------� � For OffiCe Use � ' j Permitil: �� J� 1� � 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 I I , 014 RESIDENTIAL BUILDING PERMIT APPLICATION � J7 i l (;J !7� j`i !-f :� � � 'r� �f�l/T � /L- '�'/�� Dabe: ::.J � Site Address: � �-�� �� � � ,� �.: � ; ��,� •n�s. ° �'=� Unit�: �._._,......_... , __— ->-.-iK.�- cv .'�cov ...._...,.,._ r;.� ._w..,_„_._.._ <_..�,,._..,,.�.... ��,,f_ , .._.. Name: ' � �' �., `"� ,�� Phone� ���' �� ` �-:- � ResidenU Oyyng� Address I City/Zip: S=° Q��✓�' �,..__�,. Applicant is:.,..�,..__,_.Owner _�L�...Contractor .,..,................,...,..._..._.,,_ --_-,....,_. � Type of WOfk Description ot work: ";��' d`�1 /�.'✓�� Construetion Cost: �0, ��• o%� Multi-Family Building: (Yes �� I No� — �,..,�,�.�. ,._...�._...__ _.._...,....,...._......_ _._.__ - --......_........_�._�.__........_..�.. .._. ' � /' /'� L Company: �''�c.S ::�GKG�� '�-�-?�-:�a+!' Contact: �i'�t�:�- � � , � . Contracto� Address: =>S� /'r/.;:c=<.�h i1'� city: ;��`'O�T' � .--, / � state: /�'/'�' zip: S✓�;''r,'' Phone: ✓;�L,'�";...'�fS Email: •�`'"'` `�-'`���°s:��/�x.11�� ,w•�: � _� , i-I 4 ��: - 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: ..,.,,_...._...__ �_...............__ _�....,.,...........�._ ....�.a..,..........._..___ . 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 . X � x Appll anCa Printed me ApplicanYs natura Page 1 of 3