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: ' �
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014 RESIDENTIAL BUILDING PERMIT APPLICATION
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Date: • Site Address: • Unit J�•
� � Name~� �� '/yl�✓Sno��,--,._��^_... _,.,.� Phone: ���r ����` ~�•
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� Resident/ � c,
Owner ' Address I City/Zip: J''✓�-� ��'`�
� Applicant is: Owner L� CoMractor
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Type Gf Wo�k : Description oFwork:_ 'I°Q-�' f; /`� "���.�
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COnstruction Cost: � , Z�'y' ��" Multi-Family Building;(Yes "_/No_�
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Company: e:.i?<S ��✓w�'%v": �'^�✓' Contact: ''�"{ '-t-
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� Cont�actor Address: �� �'J c�ty�
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� state: IU Zip� Phone: �' L-` ��-w3�lS�Email: G��'-+u��aa��, �' ' a��: �
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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:
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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
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ApplicanCa Prin ed ame Applicant's Signature
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