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1249 Timbershore Lane Jul 28 2014 09:51 AM HP FaxGates G.C. 7634987710 page 20 Use BLUE or BLACK Ink � ForOffieeUse---------� � j Pertnit it:_ ' �`/ � /G� I Clt ! 0�����Il � Pertnit Fee: /�� V� � 3830 Pilot ob Road � -�r� � Eagan MN 122 � Date Received: b _ � Phone:(65 675-5675 I I Fax:(651�6 55694 I Staff� � I I I �������������___�J 014 RESIDENTIAL BUILDING PERMIT APPLICATION� -� � ; � ,.., � ,-/ � ..� •'_,. Date: �' ,'=, Site Address; ��'� 'Z'� Q '`�J`; ,' �i-� ; �"`�e`'�A.o� Unit�: �..__.,.__� ..r! .�,,r � � ,:.r.,W .: �......_.....__._../_./-���/ -�y � . "'- , Name: , r�ri c.�%l.o✓• , <-.' Q� Phone: (o� � . � - Residentl , '- . ,L' �c_. Owner Address i Ciry/zip: J C,c- � Appiicant is: Owner ''�Contractor _.._..._..___...�._...e__ ....,...,,,....... ........_.._.._._..._..._...._.__..._.. �a�....,.,.,,_.,....,,.,._. Description of work: !C�*-' ��� �"r�.? Type of Work �� �.. -�? ; � r � . -Construction Cost: i/_�r �' � �/ �- Multi-Family Building� (Yes " /No_J ..�.....e _._........._.._..._.._ y__..,......�.,.,.._a.:� ,..._.__._......._._....� 'Company:�='o-!�� ��i'�- .�'r'�i�.c�`of' Contact: �'�✓v( ;e... � 7 � f ;� �� � �J /� = � Contracto� Address: <>� �- �:,�;.Sb�-� ,�/'� City. �'' ;i'��'�`��`. � .` . l � ` State: %�/Y Zip� S� =(� Phone:-v�L;�3�'.��-1 r /,�C.�=y � �/�' r�.<::tirf. � Email: � G-r,�ftej.'�vu.,i,a�%: �. � .-�- , � . � License#: L'= ��v�q--j Lead Certificabe#: /�_��; �"�=. �'�` - �._._........_.._....._.._.A_a. __..___�...W__..�. � __...,..... If the project is exe, pt from lead certification, please explain why: (see Page 3 foradditional information) � COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING � In the last 12 mont ,has the City of Eagan issued a pertnit for a similar plan basod on a master plan9 _Yes _No I yes,date and address ot master plan: n � Licensed Plumber: Phone: Mechanical Contra r: Phone: ' Sewer 8 Water Con actor: Phone: . ._.._..._.___._..v.�- --.._..___-�_.__ ..,.�._...,....,..�,.�....... ... NOTE;Plans an supportinq documents that you submit are considered to be pubJic information. Portions of � the irrformatior� ay be classified as non public if you provide spec�c reasons thaf would permit the City to fi" conclude that the r�are trade secrets. �,__....F..o- - .,____.._.___.__. ....._...,._,.�....�.,,.._,._...,......�,...�..�.. CALL BEFORE Y � DI . Call Gopher State One Call at�651)454-0002 for protection against undergraund utilily damage. Call 48 hours before you intend to dig receive locates of underground utilities. www.goeherstaleonecall.om I hereby adcnowledge t t this information is oomplete and aecurate; that the woric wiil be in confortnance wilh the ordinances and codes of the Ciry of Eagan;thal f unders this is not a permil, but only an application for a pertnit, and work is not to slart without a permit; that the work will be in accordance wilh the app ved plan in the case af work which requires a review and approval of plans. Exterior k authoriz hy a bullding it issued in acco�ance with the Minn Bullding Code mus e eompleted wifhin 180 da rtnit isouanc . � x � x Appli nt's Printed ame App canYs Signature Page 1 of 3 ;�