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1233 Timbershore Lane Jul 28 2014 09:48AM HP FaxGates G.C. 7634987710 page 11 Use BLUE or BLACK Ink � For Offloa Use � � j Permit!!: �� �� / � I Cit of Ea�aIl � �� �' � � PeRnit Fea: � 3830 Pilot nob Road � , �[ � Eagan MN 5122 � Date Received:� �T j Phone:(65 )675•56T5 � � Fax:(651) 5-5694 I S7aff: ' � I I 014 RESIDENTIAL BUILDING PERMIT APPLICATION e i � ✓ v/�� � =�`��� �V iIC7.Z,'', �✓�1 , I��(, '� ��� �r,�n�l�d -�. Date: • Site Address: • Unit J�• � � Name~� �� '/yl�✓Sno��,--,._��^_... _,.,.� Phone: ���r ����` ~�• /� � Resident/ � c, Owner ' Address I City/Zip: J''✓�-� ��'`� � Applicant is: Owner L� CoMractor �.-..,- - _,..,..�._,._.._._...�._.__..�...�.�.,�.�....._.._____.._.._..........,�.,.,�._....._._.�.... ��,.v� / �4 / � Type Gf Wo�k : Description oFwork:_ 'I°Q-�' f; /`� "���.� ��' � ' � . COnstruction Cost: � , Z�'y' ��" Multi-Family Building;(Yes "_/No_� _ ..._ _..__...._.___.�,_�_�...�..._ 7 ._._.. __....,w....�._..��...v,._.. _u.._.._.__� � � Company: e:.i?<S ��✓w�'%v": �'^�✓' Contact: ''�"{ '-t- � >c.;T� �%';�,�S,�.vv; �!✓ �!.'iicos�°: � Cont�actor Address: �� �'J c�ty� � 1,1 S.Sy'=� . ��� �� � ' --, � state: IU Zip� Phone: �' L-` ��-w3�lS�Email: G��'-+u��aa��, �' ' a��: � . =��_,�.�-.a.x License!t: ��--`7���A r �L1�•��i2 j�� 'r Lead CeRificaie#. If the project is ex pt from fead certification, please explain why:(see Page 3 for additional inforrnation) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW'BUILDING `� In the last 12 mont ,has the City of Eagan isauad a pertnit for a similar plan based o�a master plan? � _Yes _No I yes, date and address of master plan: � Licensed Plum6er: Phone: Mechanical Contra or: Phone: Sewer 8 Water Con actor: Phone: .. ...... ..__ ..,,._......._..__.� ...__...._. .....__.__ .._._..w..�._.�.....,�__._�.._�.,, NOTE:Plans an' supporting documents thaf you submit are considered to 6e public iMvrmation. Portions of the informationi ay be classiffed as non public if you provide spec�c reasons thaf would pennit Lhe City to : conclude ti►at the,�r aroe trade secrets. CALL BEFORE Y DIG. Call Gopher SWte One Call at(651)454-0002 for protection against underground utildy damage. Call 48 hours before you intend to dig i�receive locales of underground utiliiies. www.aopherstateonecall.oro I hereby acknowledge t t this information is complete and accurate;thal the work will be in coniormance with the ordinances and codes of the City of Eagan; tAat 1 understa this is not a permil, but ony an application for a permit, and wortc is not to slart without a perrnit Ihat the work will be in accordance with Ihe app ved pian in the case of wo�lc which requires a review and approval of plans. Exterlor work or by a building permlt Issu in accordance with the Mlnnesota State Bullding Code must be completed within 180 days o1 pe t Issua x / �it/l'i�/ X ApplicanCa Prin ed ame Applicant's Signature Page 1 of 3