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4146 Durham Ct 06/1712014 15:08 Les Jones Roofing,Inc. �AX�528817009 P.0181020 Use BLUE or BLACK Ink � For OfflCe U6e � , • j Permlt#: ` � I Clt� of�a�aIl � � � � Permlt Fee: � � 3830 Pitot Knoh Road Eagen MN 65122 j pele Recelved: j Phone:(861)675-6876 � � �ax:�ss��sy�-�s9a . � s��: � � i �____.__.�..����������d 2014 RESIDENTIAL BUILDING PERMIT APPLICATION y/y�!—S//�f6���-y/.S?3 un�t#: Date: �7 &Ite Address: �l 0 9�- yo 9 �ro9� --yo 9P p�a�r � <`r , .,•�:.. .,;; :`.��'`'>i�:'�::�::��;;%''r�''`i`,. _ .::.:. :.......�::,,,.. �.'�9 ::.;;,;.�,,.�::� ,... .. .� -� Name: yo p�eoPe�2rY Ga-�E �e►c.. Phone: 6s�� �.�� � `'> •,:;;;�;�;�,;.,,;;�. .,,;;.�;.; �`1,�:'.�:'>��'$I,C+i9r(1.�/'i�t,%?'�:. k 6� 9�0 ;;?:t.''%.'��.b�l�l��'.'� '��,; Address/City/Zip: R�. BO 2l 2 5 /Nti61Z�x�-�✓� �i/t/r3: /ust� ':E-�:;;'���•'ry�';a�;;f�:;; '',;�����;� Appllcant Is: Owner X Contractor ,,,.. �-.,�..,:�;;°.;4+r.�,<;�,�;,•: ,'..:.;^�, �•,':; ,:,, .,.;,��,.�,...:,,�.,��,:,,. r�� �^� :r',;;�.�; .., .�..u: %(.�/�O� �Il�/�D ��G�� d.r1�/iP/ET. �s;• '°. , : .-�•�`��':•.�,::..,.,; . ,�<•3.,��. . ; ,;a�;�;�.;,::•. DescrlpUon of work: ��;;%'�1'j!.�?;e;;:�'�,1f,UQrlc;::_ r., ;�.�,, ,•,i<:':`;� �y;. G ;�' � �'"� �'� Construction Cost: � �S Multi-Femily Building:(Yes x /N4� "����� .''r6� :.�,<,:r:\:r" `.:r r;"�,I�'I�'�;1;'�;:,r(,!t�Jf:':;?�.�I•,:•.��./ N ,�''..i.\�,.�;�� �;.r;';a'�"°:;;: Company_ d ES pQ/}��'._R L�F<A/�. /NG Contack Gs�ier s f1-�vao2so . , r� , ���Y�1•'�1.,. . ' , _ __ ;����:.:�i�4.,I�1��:�1::.i.,4,�"}'�i i?",.;'.i�r q \ 1�' J1CF,��" .�,y'' � � l/'ty. !/LG/4IlZC�N ? , , ,��r� ,��� � �^: Address: <,::';,�;4�!.#��,.,:,:�r�; s> �,;. ';-,,::t:::; :�.;° _::;��,',.�;�' Sfate: A�n/ Zip: .�.fr�20 Phone. 951— 76 7�a8/7 s,_�����• �:r:;�> ;..;.< ..:�:,. �'r;�,::k�;:�"�jr y;�'9,C��;'I;ii?"` . �;;z'��'-;�i,`;`i�;��`;;.c'`;.: Llcense#: 6.�(0� Lead CerNflcate#: .U�4r '�O 3 9�—/ If the proJect Is exempt from lead certlflcatlon,please explain why: (see Page 3 for addltlonal Information) COMPLETE THIS AR�A ONt,Y IF CONSTRUCTING A NEW BUILDING In the laat 12 months,has the Clty of Eagan(ssued a permlt for a almllar plan baeed on a maeter plan? Yes _No If yes,date and address of maeter plen: Llcensed Plumber: Phone: Mechenlcal Contractor: Phone: Sewer&Weter Contractor: Phone: ,.. �„ ]� y ,�r�/((, 1� A Y� ,:.., ., u:;y,�!�O:T �,7 �.. - .�y� ra �"'�'�','• ''�;'[ �L��: �,U�.PYL[ I ba :'�� IlI ...s,...�� •� aLI I � Q� a'a ;O��,��R� "A f. ....: .,�,,..:.�� � y,� / n- ,, :,�.. P4 �:, �/� ,(�,���1,�►,• .�.. ,.���.,�1�...3�'0. .�1 �.,..� �►,� �� +��,��� .N,, A���(.,.C!�-C n;.r; ..1, .,t.. ,�,� '��i')" � r� � � .;c)'� zvN,�l�, i v., 6 nf� .:` :i:�V9.� ��t l,��r4�� h iF � _�� ' ;4 ,, �. -,�.w�_�, g�._:; � e.�,.,ea���tI ..�.;�Iha�':, ,1� �:`t -I ' '( � a� @;,, ,,„�,. �.;:�'jr ;r�1�`ot'i�i��`rA�ir'1ia ,kk�e�.�(���,� �$,'",�1�.�-�u�&�lp;�f:yo'u; r'���_;d. ,t,.l� `f' �§`;Q�..,.� ,��,�!��? ,►�.'�.�:.:� ,.�1�'�.�', � � �rSA i..�. "If�Y�4�;� !};�4;{�,�F.� �wr ;�ii�:i.;:.;X��u; �:�,r "�/�/r/.r7�,,/�.t{{v�s3/,�.e „� .h�. .,J, y��c.fy/�?yl,y< .?;i"'�,�.��p%'t•i'.!`.,�.!. _'!'�{�`i r�y� aF,i "��i . � .J rt �� �. • ��� 'd��� ,�yN�' �..l�:,�,'i'y .�Y,Y4,��`�•fa.5.� X .��.�C,}�;I�C�??�.. 1 �CYr�Q ,�.:...�;r, .y !. �le �•.� ..,i., 1� ••i,,�. �. ';1•. CALL B�FOR�YOU DIG. Call Gophar Stale Ona Call at(66t)A64-0002 for protecUon agelnst underground utlllly demage. Ca1148 hou�s befora you Intend to dlg to recelve locates of underground u�lllles. I hereby acknowledge thet thls Intortnatlon Is camplete and accurate;thet lhe Work wlll be ln Conformence wllh the ordlnances and codes of the City of Eepan;that I underelend lhle le not e permlt, but only en appllceUOn for a permlt, and work le not t0 atart wUhout e parmlh lhal the woric wUl be In accordanee wlth the approved plan In the ease of wo�k whlch requlres e revlew entl approvel of nlane. Exterlor work autho�lzed by d bullding permlt Issuod In eccordance wlth the MlnneeotH State�ullding Code must be compleled wlthln 980 deys of permlt leeuance. . x Gµ,2rS F�MO6�?50� x G��=�,/-�'�a` AppltcanYs I'rinted Wame Appllcant's Slgnature Page 1 of a 02/1912014 12:37 Les Jones Roofing, Inc. �N{�528817009 P.0181020 Use BLUE or BLACK Irik r_�����___������� � For OHlce Uso � i , • j Permil#: `°� �� I C�t� of ���an �i l.i�°��� ' � � Pertnlf Fee: � 3830 Pllot Knob I�oad � Date Recelved: � �agan MN 66122 F�B � � 2�')j� � I Phone:(651)676.6676 I steff: I Fax:(651�676-5694 . � � �...���������.+�.��.�..�J 20�4 RESIDENTIAL BUILDING p�RMI�P�ICAT�ON � �i/�!�/ �iyG, yiy8, �isa� pate: �Cl Site Addr�e: S/D� O �! Unit#: 7a�..-i°�`;;;;�����i•".'?'„t;!%�''i'r.'�� . v.g f m �:�� �r,� �.; ,.6. yo P�eoP�rY �E� l.NG. Phone• :,'s';;;qw;l4�;�r;�, ..:;a,7:,,.(����,Gak:; Name: G !<S�- �S7/- 94�/� ;�"�`���}}}����`�d�h�l� ,: ./ �;y'���Y.��n��:�T4.�,��� Addreas/City/Zip: p�. 6S0k 212 5 /NVElZ.�-o✓1 �z!„44!±C: /uit� 6�5� 7� �nt'�i''�p�, �f� ,�,.:�ur:;i:;: .�'� y ��.' �;:i'�, t,e�_:: ���';� ii"iqir%ry�'. .e i��;:� �; v . '��:•�+��9�b,t�°"��• '�¢`�`a�'���?'�� Applicant Is: Owner /� CrOflli'OCtOf ,,,t,��.,�,�.��,.-:.� ...�; e��.s�' ' y,• `:�' '� �`•,�' � .i�. i-,y `'' '' �l�'�'��'�� '� �`�� Descriptlon of work: �ti , ,„. ,� . � .� �����0.�'�.�'`} >�', ,;M ''�E. r;;.: �; . ,,,n�,,,,t:.. ,� . . ,....,. '�;,:.;�, „�:,. ';;; -_;�, Consvuction Cost: 3� �9 �r Mulq-Famlly Bullding: (Yas x J No� ..T.F.t eJ��,uY ����� ''�i'.:.J.`I y�/..�.. ...,�,r•� �� r•.�d.. yiil.:.l�'�.:::. � / ��.�: . i' C����.���i:v,..w� : .i:t:••',1 �:;'�;,;��:.^ '�.viti, ,..�: �?�.���:� Company� �ES �ToNE3 RGOf`i1/b- /.vG Contact:Cuie�s ,�dU2.soN ��b ";?;�i'��'(�; i�iP��ji"hi::•.�T S=� . :r,4�:;.... �, a�.' {?;.,..;�,;X• � Q� � s � ,1����.�r r. LlGPQZG! _ � �ti;�r� �' '' �'�^�r:� Address: 9�/ W. �d S°lR�T' Clty: �,y,��`o��;�a���p����� �a„r� �l d'��.:A�a pL'11,j�� y(��'sI,� ' �/` ' �1 ^ a`,if,1u'1�Jfi3y.� 7i��.r,.:r,,G..`o3('.��° J^tfltA:� �t�zlP: .7J �.C� Phone: .9�5.�� 7�0 �"01��7 �^;��C�.Y :'.I::I1]'...:t�nfil' .. :.:���. ;v; `2:';�r; 'ia c;�;H'?�ir;x:ii .ri'�+�. is ':?;'7�'�;.:i;;;tt'a;��'s;�;,�,a�...a;�'�> Llcense#: �Sr(o� Lead CerUflcate tF: .UA�T �f0 3 7.7—/ If the proJect is exempt from lead certiflcatlon, please explein why: (see Page 3 for addltional Information) COMPLETE THIS AR�A�NI.Y IF CONSTRUCTING A�IEW BUILDING In the laet 12 months,has the Clty of Eagan tssuad a permlt for a sfmllar plan baaed on a master plan? ', �� _Yes _No If yes,dete end eddress of master plan: I I.fcensed Plumbe�: Phone: � Mechanlca(Contractor: Phone: Sewer&Water Contractor: Phone: ,� . ! ( ''u . � �:A' �wtuatil�ai D� �w i� .V^.. • � �.' w ��i ��1•1 . •�1 V� � ,�...� g �f '1 `:i'. � �� � S �%!f dA� s �� � '�'� i �S lr� a i3 c �. ... , ,�p��r�. #, . g� �i�� :: :� ���. �,,p .l;�.,Y,rr� :+� n.. ., . . ._ s �:� '�ar�.� .i. 1� .a ,y�..Q, �.i•� �,. ? .I � .++�:.''^�1`�1...� ` 'ti.� � ."��. ,.Y .;�'.'"'.i;M ,b �I��:., ''Y,n• �, f. �Y b ,+ 1.,. �f�:d,.,s�ori.yp��r��,:ritili�';[�.��iG r`4.�',�(��>��:��fli�� -hs;��� � ,;a(f,�di.;I@, l��r; �4�tY' o ��'`; •��.1���1� �i�>z���•'���i'�',.� t.� nt! ':Y`((n8,..��, i"`i...,'�.�'�`�'RW� ��;�. '�/t, ry ry��y;.��y tPJ,��9 �y �yy pF•,�1,�.,. .G� ���: � �i ,1. J4��,�, . . .�, t�� ,, .. s.� I ,:r.� ..a �'ti ' C 4� ����. �hT ����``� �JA °��"' x i. -,t ' Y�6 �ti. �� �t v .. A`o ',. ^, /.� v (�p�( �[� �;` � � i„� : ..�i .. ( ..'.. jY .14 ...,rr:..�TIJ��?7�1 .� �S`� /j.T�. i�:i 11 \ 'S.'f•".�.�b�tl.•l� r`'�.�� 'n�1� i�V b'Q��L. J��%: .\. .C�%�i:.ti�6::: ...!•. ;1 �`. �� .�� � :A... J. CAI,�,B�FORE YOU DIG. Cell Oopher 9tate One Cell et(661)464-0002 tor proteCGon daainet underground utlllty damage. Call48 houra bAfOre you Intend lo dlg to recelva IoCelee Ot tN1d81'�rO11114 Ulllples. www.aooheratsteonecall.om I hereby aaknowledge thet thie Informellon le complele anQ pccurele;lhat the work wlll be In con/orrnence wilh the obinenCes end codee Of the Clty of Eagen; (hat I underatand thle le not e permlt,but only an appllcaUon(or a pennll,and work le not to start vulthout e permit;thel the work will be in accordance wilh the approved plan in the ceee of work whlch repuiree a roview and approval of plane. �Xterlorwork authorized by e bullding permit 186Ued(n ecCOl'danCe With the M1111196otA&lale Bullding Code must be completed w(fhln 180 dey5 of pArmit lasuanco. x G/f-,2rs f�ND�?2sd� /'���� .G�c���-�-�� x Applicant'e Printed Name Applicant's Signature Page 1 of a