1241 Timbershore Lane Jul 28 2014 09:49AM HP FaxGates G.C. 7634987710 page 14
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� ForOHieeUse---------�
�it of Eao� ; Pertnitit ! ��� / I
b � Pertnil Fae: � (_� �
3630 Pilot ob Road �-7
Eaga�MN 122 � Date Received: l * �
Phone:(65 �675�5675 I I
Fax:(B51) 55694 � Staff: I
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; o�a RESiDENTIAL BUiLDING PERnnir aP��icarioN
'' �Y' 'u� /?3 �I ; 7 4'. �i� y' �j ' 7 L% �` ``rM/`i!.v�:�"^°' �./'�
Oate: • � SiteAddress: -' � ' � ` � •� � Unit#:
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� Name: �'I'LlSfi�'..�izC��� r';�ll�, Phone: ��;�,�,;✓� �J!?:',
� Resident/
Owner Address I City/Zip: ;�Ct� �b�! '
Applicant is: Owner '� Contractor
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Type of Work �scription ofwork: ' `-�'" �,� ��"l�"� �
rr ✓�j J:.
Construction Cost: � �� � Mulli-Family Building:(Yes '� /No�
Company: 7�G°" � ,,�iu� �� �,r<!%1%Y Contact: /%/�.� •'-z-� �
COf1t�21Ct0� Address: 3, 7'_' :/:,i�j�"'u'N �:/�'f 1`'"� Cily: �i%lilsn:,vi__
'. -'r c. � � �7 � /�', i r . /
� state� I�f 1 zip: SS';:�:! Phone: {�=- �s-'� ..; Ema iL• ��s�:�2.;• � ���:iP,•�+�'•a!=�''� _'.:;e-..�.
� �'r- ��,�p y q� ' �{l�' 'f L";: y_� ., '
� Licenae#: Lead CertificaLe#: /
If�the project is ex pt frorn lead certification, please explain why: (see Page 3 for additional information) '
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� COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING ~ Y
�
� In the last 12 mont ,has the City of Eagan Issued a permit for a similar plan based on a mastor plan7
�� _Yes _No I yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contra or: Phone:
Sewer&Water Con actor: Phone:
NOTE:Plans an supportlnq documents that you submit are considered to be public infarmafion. Portions of
the informatior� ay 6e c/assified as non public if you provide speclifc reasons thaf would permif the City te
°` _.,,_,,,,,__,__, � � ��conclude that fhey are trade secreis. �_�..�,.V
� _,.... .__..._..__
CALL BEFORE Y DIG. Can Gopher State One Call at(651)454-0002 for protection against underground utility damage. Call 48 hours
Detore you intend to dig receive locates of underground utilities. www.000herstateonecall.ora
I hereby adcnowledge t this information is oomplete and accurate;thal the work will be in confortnance with the ordinances and cades of the Cily of
Eagan;that I undersla this is not a permil, but only an application for a pertnit, and woric is nol to slart wilhout a permit Ihat the wartc will be in
accordance wilh the app ved plan in the case of work which requires a review and approval of plans.
Exteriorwork a by a building permlt Issued in accordance wilh fhe Minne Sta Building Code must complotad wlthln�80
days of i nc .
x �''ti"�� x
Appllcant's mte�i ame Ap i s Signature
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