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4091 Durham Ct
06117/2014 15:06 Les Jones Roofing,Inc. �AX�528817�9 P.013/020 Use BLUE or BLACK Ink iForOittceusa---------� • j Permit#: ` ����� j Crt� of�a�a� , . . ,� , � Permll Fee: � 3830 Pllot Knob Road Eagan MN 66122 j Dete Received: j Phone:(661)67b-567G I I Fax:(851)875-5694 . � Staff: � V�������—....�.�������J 2014 RESIDEIVTIAL BUILDING PERMIT APPLICATION yo� �0�6��f068- 4�OZD pate: Site Address:_40$9- �109l- S�os3- y45'S' R�Q�f�lrrt Cowt� Unit#: � 'A'�. I1(';� .!�,�'.. ��'� ��' ;• r.�,r:.:��:.�.. : ��,:� _,:,,',;`':::;�:;��;;,. `;:;:';;,'';; Name: �10 ��eoPa2rY G�� l N� _ _ Phone: �s�-s-.rs�/-99y9 ;, n���'id���i-:,�;; . �' .0���� �t��:'=ti'� Address/City/Zip: �O. BO k 2►2 5 /NvEJ���✓€ -��+� /�it� c4"5 d� 7� ':1:� �I.h....i•,:,��' 1 �� :�.j.1:I. �::�::::; r�:l'�i�.$',''.. ;;�:`;�y^;;:;; �•`��'''' ' Applicent is: Ownar �ConVector :.vo.;' ;;1L '.' ' �.'.C�'.^'�:.:1......+e�.:.. .�';''�;.�;V.�';'':':::__.��1,�1��:,�1'�'i�::�i, p � �,'-.:.�'./,;..��'?.:�.;1:. :,,. '' � = i�".�-�•,��%'''`""'� Description of work: � OvE �4N� .2�F�A,C.�' .J/D/NG; '{�'i?��',bf�ui�����:�'; - ��•r.'`"���"� ';`'�` '`'' '"'�:� construct�on�ost:�23�oD7� �� Multl-Famlly Bullding:(Yes x /No� :M1.'4�::' �..'1�`::'S'+ �'�+,�,J ',i/1` �.;':�I'rl���..�'� �':��1`.�.'. / "�;� '� ' '�"� Compeny: �E� ,ToNE3' RGOFfi✓lr /NG Contact:C�l�et� �D�72so�/ , -'. ;;,.,� - . ,:�,,i;.: ; ,,,^• ';,;c';;:•_ .s,w .:,•,�;;,..:...R�;,..:.:, ,r',...�,�.,:..; ...'b.'i'.)IN:�'. . :.s:�('�.. -�.:� ..x,. . ,,;.,:.....,.:.:.,r -�:,, Address: 9�f� W. 80� srR..��r'" c� .vl�-�n.✓ ��::,;,% ;.: `{:>., . . ,, , ,_....,....__ �v= ��,ac?��..�_ �n ..___,,..._... ,,;4britrac��;r' �rs r�?;"'�,;9':'�::;�r= :`r�:��: :> $��:�rZlp: �fk�'�� Phone: 9SA- 7(0 7-0�8/7 ':.i���:::^ ,;;:����..;��': �•'. - ';�i �� i �i.� �� ��- .;; ���<!� ��cense st: �S6D Lead Certlflcate tl: .UA-T `r`� � 7�-/ If the project is exempt from lead certlflcatlon,please explein why: (see Page 3 for edditionel information) COMP�.ET�THIS AREA ONL.Y IF CONSTRUCTING A NEW BU(1,DING (n the last 12 months,has the Clty af�agan(ssued a permlt for a slmllar plan based on a master plan? � Yes _No If yes,dele end addresB of inester plen: Llcensed Plumber: Phone: Mechanlcal Cvntractor; Phone; 8ewe�&Water Contractor: Phone: ... .... . ...-..>:�-.,.,....,>�.��....,,:.,.,•.:�,,..,.>. . ,,, ,,, _ ,.:. �S . . �,/ ,:,... .. ;•,. :,..:�,�..,.:: ........ �-� ,�:,,.:,�.,,.:.::.,:,.. ��Vd..�:�Plan�:an1µ;suPp.or.�t(tl,�rd't�,atl�e���fha�you�sul5rtl�,t���'�1fr���d�`Y,e.ai'�fb;�ti��'Pt►6y�4�'rl�dr►5t��t�atl�.�f.',�i"� i��t's�}�f::,� 5 p � � 4 , f I�.0 ' - {'t %1,. s �_ � � ,. ��.� .I s:v' i � � f�r �r_�,�Y A,! •^1�'r.y'`` — I• r,. � J����'���,�I�t�or�i�z��n.M'ayibe,Cl��s�.,�l�� �a��'n�r.'i:p�6��e l��Q�;,��,,la�fld���p�g;.�)�f�r'�a��ns;��,af;vy�ul�►�per°rrt����:��.;���y.,�b;:•�:, �v V It i ,. : ,,i, y ,�5�r,, e, ie 3.���� tu �� „i�•. +�:.4� a � �7� �� r �v �i .. .� . / r � '` '.^^• 'I /4 . ����., p.,.0 . . , ` ° . {�u � .�i,tiS. t� c b4\1 F,�g:�;�r� :c � ,Yz y „ ?,i'';�, F ' ' a�14, ;' ,�t��cade�t a�`�t�IC., �l,C�i� °���:$ Q "J• SJ�� ��.� �J���1"� .� ;, y� ..�. �' • •......a.._.. .... '..r � ..... ... �f. .1.. . .t�..Th?si. •t i. .:�.� .D. 1. CALL BEFORE YOU DIG. Call Gophar Stata Ono Call at(861)A64-0002 fo�pratecflon egelnst underground uUl(ty demage. Call 48 houra before you Intend to dlg to recelve locetea of underground ut111Ges, www.00pherstaleQnecaA.ara � I hereby acknowledge Ihet thls Infarmatlon Is complefe and aocurate;that the work will be In CoMormanCe with lhe ordlnanCee anQ codee of the Clry of Eagan;thel I understend thls Ia not a pertnlf, but only an eppllcatlon for e permlt, end wotk is not to etert wtlhout e pertnit;thal the w0�k will be In aCCOrdance wlEh the epproved plan In the case of work whlch requlres e�eview end approvel of plans. Extarlor work authorizad by a bullding perml!Issued In accordenco wlth the Mlnnesota 9tate Bullding Code mu9t be completed wlthln 780 days of permlt Issuance. x cH�krs f�MD�2sa�1/ x �� G��-�� Appllcant's Printed Neme Appllcant's Slgnature Page 1 M 9 0211912014 12:35 Les Jones Roofing,Inc. �A��528817009 P.0131020 Use BLUE or BLACK Ink r.���������������� � � �or O(fice Use � • ; P8►mu�: �7 5� i City of �a�aIl ��������a � � � �� � Permlt Fee: 3830 Pllot Knob Road F�$ ' � �O'� I I �agan MN 65122 ( Deta Recalved: � Phone:(6g1)6�'G-K67'g j staff: I Fax:(651)67b-568q . � � r����������������d 2014 RESIDENTIAL BUII�DING PERMI�APPLICATION ! �loGy yo�G. 40�� �O�o � . Date: 2' I� � 31te Address: Unit#; ,,.�.<.�.,.fd,,..`Y ........ :, . . ;.;�,..�.,a�•:,, r �j �`;E ;�� .,���;,���y;;�:;�°� �ta,;;, � Name: yo P2oP42rY �A-�.E. 6/vL. Phone: �5�- S.st/- 99�l9 k'F,�,W 1 �.1;: •i,.�d r �'��,L/�s � I/ P f��dy�y������Q''6���.'1'.Y��• :��,�.^���<�V1�.Kgl�:o.` Address/Cily/Zip: �P�• Bp fL �l2 5 /NvEJ2�-0✓d -�zl�is4'Y: /u�tt� �3Xy 9Gi �i.� . N�'`, /��'y�•y ?, � ��� �'",'y�"�'t''M��*'� �� Applicant is: Owner �Contractor , _���.�s.,: r. .,,� ,;`':f'�'�'' ��t�`"��y;`. ;1� l�GMo �.D ,, .. ��.�-�.��: , ' -.� bescription ofwork: GLc l��'� �o,df .,��';R���_o�r�;v.c�:�l�;,:,; �� �' , ,-,�..,�'�i�����._,.:a�,, A 3 9 x � i; , ,.,�_ f , Constructlon Cos� Multl-Famlly Bullding: (Yes 1 No_) �.ry, .T'i.•YYY�� '�AC%, ��/y' :.'�!,%fA,YA ���+,,a�>�� !1'•'�*'�? .. ,�`;�,i Compeny: �E5 �'oN63 RciO�s�/lr. 1.vG ConEact: C�sier s ,4ivDd72so� r:u ' �,.�,;�,. � �....f '�,k'"' �� � . �^��,:1 1. . / i:a. . >a_.��'a ., ,; Addl'A99: 7�f � 80� �Ti�`ti'7� Clhl: ��lLl�N , '„y�,'(�a°Orl�,�r� I�ra..s�,�;t�. ���� r:,,,..,. ...+.,.y, . �f:�,;. p ��`"-„�fv,'•a�'"�v,�..�?�„;� State: A Inl Zlp: .�.�`��20 Phone: 9'SA� 7�+ 7-e�8/9 :�;::59.;��,�,.'�< i f� ,, -,�' � •�''',.��1�;�: a. 4: �� :,.x�y�;.�>:��.,�;�F,'.h,>;�i;���.:���, Llcense#: ���oD - --�eadCe�tlFlcate#: .vA.7— `f039R-/ If the proJect Is exempt from lead ce�Eification, please explaln why:(see Page 3 for add(ttonal informatlon) CdMPLETE THIS AREA ONLY I� CONSTaUC71NG A NEW BUILbING In the last 12 monthe,haa the Clty of EagAn lesued e permlt tor a almllar plen based on a mester plen? _Yes _No If yes,date and address of master plan: Llcensed Plumber. Phone: Mechanlcal Contrector: Phone: Sewer 8 Water Contractor: Phone: �a,���fiil ,T " ! "< <� � , cf� �t ,�ct'�s, �� t?- q ��.a R � �R', �;���L`� G�!� `.¢�,�� ����tr�Jf�fQ� ��a�+,�� ,�e;��/as�stf.�����:;�� ��u �`a �u� �� � . � �. ��rh��f�w��'�"� ��tY��-��k >t �;'� �; ;!� t �.. �' �, -,.. .,� . �. �:� �;,-.Y� p►��, �`p. �'�,:w � .��_ �.� ,� � ,� .,.,,;�,;�� _ � �� ,��'�4.': 1������._!rr ° � . w"'r 1 a A� .� fN py .��.-..A (� /�(. . �. t��.�`),� � piM, ...l� q _ '. , ,.. ,,; � 4:iF, f�� ..:' „':..1 ...�. ::...�i i.io,'I `Y}�5 3 �'�.V. c1S.l w.d �.x. .:i14 _ , ., ... .. . . , . . �. . , • .. ...; ,,{�,' CALL B��OR�YOU DI�. Call Gophar State One Call at(661y 484-0002 for protecGon agalnat under�round ullllty damape. Catl 48 houra be/ora you Intend to dlg to rocelve locetes of underground ulNltles. I heroby ecknowladge lhet thls Informatlon la Complate end accurate;lhat the wodc wlll ba In conformance wllh Iha ordlnances and codes of 1ha Clty of Eepan; thet I understand lhls Is nol a pennit,but only en appllcaUon for a paRnit,and work la nol to slart wllhout a permlt; thal Ihe work wtll be In ac�ordance wllh the epproved plan In the cese of wo�C whtc�requlres a revlew and approval of plans. �xterlor work euthorized by e bullding pArmlt lssued In accordanco wlth lhe Mlnnesota Stata Bullding Coda must ba complatad wlthtn 1A0 days of qermlt Issuance. x GI•f-2r3 �ND6�2s0it/ x /k�� G�C�iGr�Gr-� AppllcanYs Printed Name Appllcant'a Slgnsture Paae 1 of 3'