unit D Oct 2 2014 12: 05PM Crest Exter ors 651-463-8095 P, 4
Use BLUE o��LACK Ink
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� For Offlce Use �
' j Permil#: � `��� �� j
Clty of �a�a� ; Permil Fee: r /�_ �� �
3630 Pllot Knob Road � �
Eagan MN 66122 � Dale Recei�ed:�� j
Phone:(661)676-567b � �
Fax;(661)67b•5694 I Sta�: �
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2014 RESIDENTIAL BUILDING PERMIT APPLICA710N
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Date:'� Site Address: Unit#:
Name:CI� �� ��I���� J�� _Phon�LV�,�JI�J�I�1` (l,�l�
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�" ,0', Bt Address I Gify/Zip: Q�
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.�Sa�,:���,:.��::� Applicant is: Owner Contractor
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z '• Description of work: 1�--�C�- '
� .e.�Of�
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• �� Construction Cost� ZW �� Mul6-Family Building:(Yes�/No�
. •, • Company:\��jl _ �1 Y,������l._-�. i _Contacl: I�lJ1��/ _
, .- `� ;c�„e-w�.: Address:�7�h�_Ci�'��Y� / 1 � �\'r -- City: . � �
��nfra��,or.•
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• - • State:�Zip���_�'�' Phone: � I�ma��:(XQ,S .1�1�C� �r1t1C�C��r��
License�l:C)��U1�}-� ��� �. Lead Certifica[e#:
If the project is exempt from lead certiflcatlon, please explain why:(see Page 3 for additional information)
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COMPLETE 7HIS A A ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months,has the Clty of Eagan issued a pemtlt for a similar plan bseed on a master plan7
_Yes _No If yes,date and address of master plan'
Llcensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer&Water Contracfor: Phone:
IV. TE:Plans and:s�o►��ng d cuirie tis"ina'� � -�re°'o" - � ���e' u611c informafion. Portlons of
t e'ihfontl"�e��li�mayb�e�classife �. ► e,,. , _,�,., ��d,f�vould�permiftHe�Ci(y�o
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CALL BEFORE YOU DIG. Call Oopher Slate Ona Call ai(861)454�OOOP lor prolectlon againsl underground utllily damage, Call 4B hours
before you inlend lo dIg lo�ecelve locales oi uhderg�ound uUllUes. www.000her laleonecall.ora
I hereby acknowledge Ihal lhis Infofmal�On Is complete and accurale;lltal Ihe work will be in con(ormance wlth lhe ordinances and codes of the City of
Eagan;Ihal I undersland lhis Is nol a permii, but only sn appllcaUon for a perrnil, and work Is not to slert w+lnoui a permll; thal lhe woAc wlll be in
aCCOfAance with the approved pian In ihe case of work which reqUires a reNew and approval of plens.
Exterlorwork authorizad by a bullding pertnif is6ued In accovdance wlth lhe Minnesoia State Building Coda must be completed�vitnln 180
days o1 permll Issuance.
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ApplfcanYs Printed Name Applic nts Igneture
Page 1 oF 3
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