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unit D Oct 2 2014 12. 05PM Crest Exteriors 651-463-8095 P. 5 Use BLUE or BLACK Ink �---------,-------� � For Office Use i J�7�10�- i Clty of Ea�a� , Permil#: I ' �7fi��� ' � Permll fes: � 3830 Pilot Knob Road j GZ � f j Eagan MN 66122 � Da1e Recelved: V � Phone;(661)676•5675 I Staff: � Fax;(661)676-5694 � � `__-_____ �._-____J 2014 RESIDENTIAL BUILDING PERMIT APPLICATION Date:I� Site Address: ' Unit�I: Name:l� Phon��,�J���7�1� (1\��� ResiilenU P - . � � ��''�' Address/Ci p Owner h+/zt � ����,;,:_ ;,t•;.::,�,. : Applicant is: Owner Contractor ,:,�, R;-�•*�.�.;.�E,� �� ��R �a'�''�P`' Descrlption of work: - ' s e'of, o�� �'�.r..�� �l. /� "�-'' ' Canstruction Cosl:� v`� y Buildin :(Yes�1 No_� � Multi-Famil g :- ,. .. • Company:l J► �(�jl x�,( �1)1 J� LLJ� i _ContacL��,,� ,';�� �:: Address:�7 � I 1 � (\����Clty: . �;f3ontractor ��;,<--::�. (� �.,,`' • State:�Zip� lJ��'�' Phone: � `�mall:��,s1�T�.���r�� �Q,��2�r►�t License#:���\Y�7-�'�VJ���� Leed Ce�tificate#: If the project is exempt from lead certfflcatlon, please explain why: (see Page 3 for additional information) U �, �� 1 ;�� r� �� ' r, � � - ,i' 1� -� C� , COMPLETE THIS A A ONLY IF CONSTRUCTING A N�W BUILDING In the last 12 months,has the Clty of Eagan issued a permlt for a similar plan based on a master ptan9 ,�Yes _No If yes,date and address of master plan: Llcensed Plumber. Phone: Mechanfcal Contractor: Phone: Sewer&WaEer Contractor: Phone: NOTE:Plansandsu;���tl"� 'cu"`'e�� -Y�a�+q!/; ��i `�`r'e'cq P ')'E�'_o�lii.e' ubllcinfo►7ndtion. Port7onsof tfie informe'`�%n htay�°classif -i�y ��c' �. , ��would permi��Iie�City to .. _ . . ,- : . `_`Eo � e_ a��t r,a ts . .. � . ' CALL BEFORE YOU DIG. Call Gapher Stete Ona Call al(ebi)464•0002(o�protecllon againsl undefground ulility damage, Call 48 hours before you i�lend lo dlg to recelve locales of underground uIIllUes. www. o hersl e Il.or 1 hereby acknowledge thal lhis inforrnalion IS complete and accurale:lhal the work wlll be in con(ormance wlth lhe ordinanc�snd codes of lhe City of �agan;lhal I understand►hls Is not a permil, but only en appllcallon for a permil, end wollc fs not lo sleri wilhout a permll; Ihal lhe work v✓�II be in accordence wllh the approved plen(n lhe ease of work which requifes e fevlew and approval of plBnS. Ezterlor work authorizad hy a bullding permit issued In aeeordance wlth the Minne6ota Slale 8ullding Cada must 6a compleEed witnln 180 days of parmll Issuance. X ; �,W���.C�'�� � x . Applicant's P�Inted Name Applic nt's Slgnature Page 1 oF 3