unit A Oct 2 2014 12: 04PM Crest Exter ors 651-463-8095 P• 1
Use BLUE or BLACK ink
� For Offica Usa^ � �
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f a��f9 �
Clt of �a a� j Permit#: I
� � � Permll Fae� ��J�v� �� �
3830 Pllot Knob Road � � �/� �
Eagan MN 55122 � oale Recelved: �
Phone: (651)676•b675 �
Fax:(651 676-6694 1 Slaff: �_ �
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2014 RESIDENTIAL BUILDING PERMIT APPLICATION �� �;�
Date:l� Site Address: Unit#:
. . Name, l� Phon��� /���` (1,���
=Resiclent�-� � 1 �-
`?Q��� Address I Ciry I zip: " �
���'��` `� �' �� ` Applicant is: Owner Conlractor
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' Oestriptlon of work;
-tt�e Of���,:
,�;;. .�.,�... . C� p
- � � -� ConstrucUon Cost ��J � � b Multi-Family euilding:(Ye /No�)
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- Company:\�l Y�j� I"'"�,I � ��� � _Contacf' —
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,��OI'1EfdC�Ot` � Address:7��fl� �� � r\�'I( Ciry: �
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• ' State: V Zip��„� Phone: (�mall:l.,�Q,��.���r� o�l rn�r�l
Licens�#:�)C� Y� �� r Lead Certtficats#:
IF the project is eXempt from lead certiFicatlOn, please explain why: (see Page 3 for additional inFormation)
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COMPL�TE TH15 A A ONLY IF corvSTRUCTING a NEW BUILDING
In the last 12 months,has the Clty of Eagan issued a pertrllt fOr a similar plan based on a master plan?
_Yes _No If yes,date and address of masfer plan:
Llcensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewar&Water ConEractor: Phone:
NOTE:Plans and support/n�,q,J�dQ u�``e"fs;fhaf .�u.S ' �e corisi e` .Q�be pu6lic lnforntat�on. Porf�ons of
,�. � �,s s,-,-:. z°-��
ffie iritorrh�i�td)i may 6e classifi� ,a • e �•t at would perinit the G'ity to
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CALL BEFORE YOU DIG. Call Gopher Stste One Call at(651)464-0002(or protecllon againsl underground Wliiy damage, Call 48 hours
6etore you inlend lo O�g lo recelve locales of underground ulilides. www. a hersl all.or
I hereby eCknowledga that Lhls informal�on Is complele and accurale;Ihat lhe work wlll be in conforrnance�+rilh lhe ordiaances antl codes of lhe Cily of I
Eagan; lhat I undersland Ihls ls nol a permit, bul only an eppllcaUon for a permil, end work Is not to slart vrilhout a permil; fhal the work w�ll be in
accurdance wlth the approved plan in lhe case of work whlch reQui�es a review and approval of plens.
Exterlor work authoraed by a bullding perm(t issuad in aceorclance wlth the Minnasel.a ate Building Code must he completed�•�iEhln 180
days ol permlt Issuance.
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Appllcant's Printed Name Applic ts Signature
Page 1 0(3
r
For Oaks Us"
,‘ Permit t /5'.(7 -GP- Ai
•,...... EAGAN
....
Pwmit Fee: 6.. '. 7 S‘ki°
Dote Recehect
3830 PLOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 I TOO.(651)464-8535 I FAX(651)875-5864 Staff
.1.%u1lolln9=nsDectIonstatertY0feeilan com J
2019 RESIDENTIAL BUILDING PERMIT APPLICATION
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Does:.,, Site Address: /I/17 bt)c-levopoot t(i unit#:
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Residenu -L ,, -,i't J.).4. Phone: 4- (.. / . ,
Address/City I Zip: //7i"
Owner --
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Owner ,\:
16 Contractor..---- -
—- - -- ..--.. 14 .....--...... .--_
Descriphon of wort
.1/L-----
Type of Wort
1
1.__ ____I Construction cast...ix-- (--/ I':-,' -) .C.- --- Multi-Family Budding (Yes_____/No )
company3 l V.. V-..1;.1 tr....".cl -E Ai C.- contact 0(., £Ty-e.L.L--1,-'r-L1-
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Address 11 Z 0 0 i:1 lk 4., ;.,:c-,-- 6 1 v A Ad -' obi 1-4-1
! Contractor
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I state p ei,, zip S l'e y 1 Pnone k 5 ., - t , , - -Ernail ..; I ,.• t 0- _i
I
, _ , 1 license t. 1.- - j i'___' C- 1 9 Lead Certifies*f, 1/21..X.emiddmia....., fo • /
tf the project is exempt from lead certification, please explain why.
t----
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
in the last 12 months.has the City of Eagan issued a permit bra similar plan booed on a mates plan?
1 Yes No It yes,date and address of master plan:
i _____ — •
I Licensed Plumber: Phone:
I
;
Meal Contractor: Phone:
Sewer a Water Contractor Phone:
i
I Fire Suppression Contractor: Phone:
NOTE Plena end supsaig dtioallialle lharyoe auto*ere ocupelchwed ea be pubic inikeeseelon. Portieres et the Manna/ea may be
L clanged as nonjoblic W you perukes speak moons tbat amulet ponodt toe CAW So eanclUde OW Ewan/lode riectiele.
You ntay subscribe to metre an alachunIc acatIkation from the(Myer proposed ondlaanoei by signing up for an anvil wale en the Gays
wobble at www.cilWieettartiXtaftUtidyeribe.
Exterior work authorised by a building pone issued is accordance with the kenaescite Stale Suedime Code most be compleSed with*10
dale of pone;Au.BEFORE YOU Cal Gopher Stake Oat Call at(WI 414411102 kr protection against underground utility damage Cat 48 Peons before you
Intend to dig to receive locates of urslosrand Utlibell. reaugipbtrgAitanteOlj,1041
I hereby ecimcmiodas*at this dominion il connPfsts and ecis, le;the the work we be in conformance with the ordinenoes and codes of the City of
Upon, Wei I understand the is nal a pantie hit only an application kr a permit, and work 0 not to stwt**hod a Oka* tile the wore will be el
accordance with the approved pion in the ogee of work which requites a review and approve oisimoo.. ______
1 L,.......-- . s---co ."-IC.....rt. t--, Ci---------A._ -------=---‘---__ —__ __
Applicant's Printed Name Almiticant's Signature _