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Permit
City of Eap I P rmi Fee:
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e t o2J
3830 Pilot Knob Road I
Eagan MN 55122 SEP 4 2014 1 Date Received: A ~T
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff: I
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit
Name. Phone: cos- qg00
Resident/
Owner Address/ City /Zip:_ Applicant is: Owner -V--Lontractor
Type of Work Description of work:
Construction Cost: Multi-Family Building: (Yes ~No
Company: Contact:
i
Address: City: kfa2cl r S
k Contractor
State Zip: SS033 Phone: 6C(-2J0-KU Email: (/K6IG00 p e4zero, C.Uvt^-
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License Lead Certificate
1If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exte 'or work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days o permit issuance.
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JAA u x S (/-~i(
Applicant's Printed Name Applicant's Signature
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