4132 Durham Ct 06/17/2014 15:07 Les Jones Roofing,Inc. �AX�518817009 P.017/020
Use �LU�or BI.ACK Ink
� ForOffICeU9e`� ` ^'^f—^�
. . ' j Permit#: �✓� ` � 1
C�ty of�a�a� � Pertnit Fee: � . � �
3830 Pllot Knob Road � �
Eagan MN 65122 j Da1e Recelved: �
Phone:(651)675-6675 I 1
Fax:(6G1)675-6694 , � S��: �
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2014 RESIDENTIAL BUILDING PERMIT APPLICATION
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�:A;. ',J=:`�''�:,;;,�` :��;;;; --<> Conetructlon�oet: ��0. Multi-Family Bullding;(Yas x i No`)
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� `�"` "�'� Address: 9Y l (N, g4� 9Y�� Clty: �GOt�a�
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�'�.� �;��;�i,,::�� Ucense#: /��o� l.ead Certlflcate#: .U,4T `f 0 � ��—/
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If the proJect Is exempt from lead certification,please explaln why: (see Page 3 for addltlonal informatlon)
COMPI.ETE THIS AR�A ONLY I�CONSTRUCTING A NEW BUILDING
In the laet 12 monthe, has the City of Eagan Issued a permlt for a elm)lar plan baeed on a maeter plan?
�Yes __ IVo If yes,de6�end address of inester plan,
Licensed Plumber: Phone:
Mechanlcal Contractor: Phone:
Sewer&Water Cohtractor: Phona:
:;;,�N��T ��PI n� "�l;�u �..o' ii ;.b"�. .��i ;f �f;�:o��,; f°"r�;�:°h •s.. .:,• .r.���� p��c;r`°�...,��a l� :::. �:Ytl3 s=.��. T,
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CALL BEFORE YOU DIG. Cell Oophor Steto Ono Call et(661)464-0002 for pro►ecllon ageinet untlergrountl uGlity dama8e. Call 48 houre
before you Intend lo dip to recelve locatee of underground ut�lltlee, www.aoohereteteonecell.ora
I hereby acknowledae lhat thie Informedon le complete and accurate;lhal Ihe work wlll be In vonformence wllh lhe ordlnences and codes of tAe Clty ot
Eagen;thet I underetend thle le not a pemntl, but only an eppllcation for a permit, end work le no1 to atart without e pe�mlt; that Ihe work wNi be In
accarcfencewllh the epproved plen in the cese ofworkwhich reputree a review and approval of plene.
Exterlor work author►zed by a bullding parmtt Issued In accordance with the Mlnnesota State gulidlne Code must be completed withln 180
days of permlt Issuance.
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Appllcant's Printed Name Applicant's Sia�ature
Page 1 Of 9
02/1912014 12:37 Les Jones Roofing,Inc. �A�9528817009 P.0171020
Use BLUE or BLACK IHk
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� For omce Uso �
• j Pamtit#: ' ����I
City of Ea�aIl � '- � � Permlt Fee:,_,��— i
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3830 Pllot Knob Road
Eagan MN 6b122 j Date Recelved: j
i'hone:(651)6yG-G67G FEB 1 � �Si�I� i s�a�: i
Fax:(657)675�694 . � �
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2014 RESIDENTIAL BUILDING PERMI�PPL,ICATION
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Date: l� ` Site Address: Yia�� yi3o, yi��, H/ f /,�U.2HrPsrt Cod.C7'' Unit#:
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�:D�� ���NI�`'•I'f�/�N'y:�•�l�;�w;: Name: �10 P�eoPr�2ry c�.��NG• Phone: �sr- ss+� �'9yy
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.>yiv���l•h�� �fp ` '�:� Address/Clty/Zip: �D• �OK 2l 2 ✓� /NVE12.�-0✓1 �_ � 9
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N,����;�"�''.,�:,:'�'���.,;.:�a����t ApplicanE is: Owner x ConU'actor
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�� ,�. ��r. Description of work: ��M� � ��%�'� � { � �
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p��Y�r ��'��'`�,;.' �' � '�'� Constructlon Cost: �f ��D� � Multl-Famlly Bullding: (Yes x /No�
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;.�r �+��,� r �`..�,�,.�,N,'��'�; Compeny: �ES �TaNE3 Rao,�ln/fr /NG Contact:Ca�e�r� �Dr�2so
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� A- r�' �,� address:.9�! IN.
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:"� 4.. �,p�s.,�"�'��i°�;,iJy`� state:�Zlp: .�.f��fE2o Phone: 9�SA- 76 7-a8/�
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y;,`,. ��;1y�- �:�,.:�, Ucense#: ���o� Lead Certlflcate#: .U.47- -/
(f tha project is exempt from lead certlflcatlon, please explain why:(see Page 3 for addltlonal Information) ,
I
COIVIpLETE 1'HIS AREA ONI,Y IF CONSTRUCTING A NEW BUILDING
In the last 12 monthe�hae the Clty o(Eagan(ssued a permlt for a almllar plan baeed on a master plan?
� _Yea No If yes,date and address of master plan:
Llcensed Plumber: Phone:
Mechanlcal Contractor: Phone:
8ewer&Water Contractor: Phone:
i �+� `� ! - c y� .pr. �' :� w � �r 1. w qu, �y.
7f.�J��aFr��c;�:.� �.�d�..a, �A�.�'- � �y` ��.����'�34n��U''�N� Gi� ,r' �i�. ,i��0 .,.ep, i �/,Ot ,���P��l fy,�`i
'i Y•����� ^��f��i"'�'Ir.y��� {���RI�� ua 1 �.�a�4�ikl�vj��blrqd��� �`Gc��r�o�1�Y�� f�� ���n5,,����y��y�t7/������(�e;��'t'y�p`�:�,�
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CALL BEFOR�YOU pIG. Call Gopher Stale Ono Call at(661)464•0002 for proleGlon agalnst undetground uQllty damege. Catl 48 houre
before you Inlend lo dlg to recelve locates of underground utUltlee. www.aaohereteleonecall.oro
I hereby acknowledge(het thls[nformatlen Is complete and aocurate;thet the wo�k wlll be In contortnance wllh the ordlnancee end codee of the Clty oF
Eegen;thet I understand thls la nol a permlb bul oNy en eppltcetlon for a permlt,and work Is not to atan wlthout a permlt;that lhe work wtll be In
accardance wtth the approved plan In Ihe caee of work whlch requlree a revlew and approval of plans.
Exterlar wark fluthortzed by a butlding parmlt lssued In accordence wlth the Mlnneaofe Steta Bullding Coda must ba completed wlthln 180
days of parmlt 199uance.
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Appllcant's t'rinted Name � Appticant's Slgnature
Page 1 of 3