3826 Country Creek Way Use BLUE or BLACK Ink
. . . . �________________� .
I For Office Use �
' � Permit#: � Ci 3��
City of ����� � �,��f ;
� Permit Fee:
3830 Pilot Knob Road � �
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I I
Fax: (651)675-5694 I Staff: �
I I
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
' Date: �v Site Address: G-- � Unit#:
' Name: ������ �, Phone:� a�r���
Resident/
=Owner ` Address/City/Zip: �z-� ' U.��
' Applicant is: Owner Contractor
Type of Work : Description of work: —
Construction Cost: Multi-Family Building: (Yes /No_�
- Company: ��``���.�,�C".,,�'� ,�'(,� S Contact:���
C011tCaCt01' ' Address: `—� City: �u�n��. ,I � �
State:�Zip:����,'� Phone: �Z- ` ail:�`Co i,��(n�Z 1�"�'L. ° Cb
License#: C- � Lead Certificate#:
If 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
fhe information may be classified as non-public if you provide 5pecific reasons that wou/d permit fhe City to
conclude that the 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.aopherstateonecall.orq
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 � 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.
Exterior work authorized by a building permit issued in accordance with the Minnesota S te Building Code must be completed within 180
days of permit issuance.
x �%//�-�""ll�'_l � �li � A �--- x
Appli anYs Printed Name Appli Ys Signature
Page 1 of 3
Use BLUE or BLACK Ink
. � r—————————————————�
I For Office Use �
�
' � Permit#: ��''��� _ � �
Clty of ����Il � �s � ;
� Permit Fee:
3830 Pilot Knob Road � �
Eagan MN 55122 � Date Received: �
Phone:(651)675-5675 I I
Fax: (651)675-5694 i Staff: i
2015 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit#:
� �, Name: ��lt� /7�.-��'��1� Phone:
� 3����A Z'. p� i . /� ` 1
�1�t��';' Address/City/Zip: � b��U �c�s.n�r-/ l..0 eeL `�J�`�- �G�✓� M f�`
�� �,
'� j ; Applicant is: Owner Contractor
: � s ,, �����,��
Description of work:
T�pB c�1�t�r'k� �
' 6%��, , � Construction Cost: 7�d�_ Multi-Family Building: {Yes /No�
�� r
Company: _1 V t��`��rh��C"T et'1 v�s �41�hC Contact:
` ��,�1��#����'� Address:�2� 1 I T•MI�^ 1 l.��i.Q. L r1 J City: ��Cf� lo !Y�w"�'
a p��. 1 S �,���. / �
State:Mh Zip:��� Phone:i7����r��sla�mail:
� /�/ Z/ �r,�
;` License#: �9 Lead Certificate#: ! �'� �'�� ✓Y� `/ 9'-�y�-(
If the project is exempt from lead certification, please explain why:
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:
Fire Suppression Contractor: Phone:
���r f���n�'����������`�'�v��� t�.b� ` � �c�� �r^�r���f��`
���rt��v�����i��e����a��cr��#f�c�`',���t a ���`�� ��r���z���#� �o
,�r ,. , . � -- ., �� ��� ��t„ 3� at�e��,s�a���� ���5� � ��
� �� .�
.
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.qoaherstateonecall.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.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance. �
x t-�—��✓�'s U `/�% x ,t^..--.��...
Applicant's Printed Name ApplicanYs Signature
Page 1 of 3