unit E O�t, 2. 2014 12, 05PM Crest Exterlors 651-463-8095 P, 6
� Use BLUE or BLACK Ink
� For Offlce Use v y~ I
' j Permil#: � � � j
Clty of Ea�a� � Permil Fee; —1 u �fl �
3830 Pllot Knob Roed � I
�agan MN 55122 � Dale Received; ` � �
Phone:(651)675-5675 � �
Fax:(651)875-5694 � S�aK. �
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`_�....�.--.___________J
2014 RESIDENTIAL BUILQING PERMIT APPLICATION
Date:�V Site Address:��1' r Unit#:
Name:CI�� n�i �� �I 1 a 1 �.'K� Phon�U►�/J�1^ C�`��/
.�R�sJilentl � C
��gr Address/Ciry/Zlp: 7 • I
�„��ti,,^��_ Applicant is: Owner Conlractor
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„e�,'�?:�-1']y,� . � n
.�-.��,�a��` Descriplion of work: 1�-�� �
$;Q,� of �.
� �r^.�� ,�3�-•,.
"`�'� ' " Conslruction Cosk� � Multl•Family Building:(Ye �l No_)
.,.__..�.... ,�:_--,:- Company:l����1 CJ\�,��l)��� i Contack��.)
�:-��� �-��-��.. Address:�Z.r)t� /_ �� �Y� '� l_l ��l - City: , 1� �
'.Q�,�tr'a�tor.: " .
'' ' � � S�ate;�Zip��1"'} Phone, O��kmall:�S � ( .rr1Q����
Llcense�F:C)C�U+'}-t Or� Lead Certlflcate#:
If the project is exempt from lead certlflcation, please explain why: (see Page 3 for additlonal inFormation}
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Q� (' ►` `^Q � r � — i 1 � � , C ,
COMPLET�THIS A A ONLY IF CONSTRUCTING A NEW BUILDING
In the las(12 months,has the City of Eagan issued a pemtit for a similar plan based on a master plan7
_Yes _No If yes,date and address of master plan:
�icsnsed Plumber: Phone: �
Mechanlcal Contractor; Phone:
Sewer&Water Contractor: Phone:
NOTE:P/ans a{�d supporting dqc�irr'�enfS't" � s -`i a're con�lder" 'tl:o' �'' u6lic information.,PPorHons of
�t]`ie Inforina[ion�inaytie c1�sSrf( . �if d ' s � ^ s ns�af would pBim►f'ttie'Crfy fo
' '�~ ��c °a`�' �'��i 'frade s�cr Es�
CALL BEFORE YOU DIG. Csi�Gopher Stata Ona Call al(681)464•0002 for prolecUon agalnsl underground utllity damage. Call 4B hours
beFore you Infend lo dig to receive localag of underground uUlilles. www. o herslate I r
I hereby acknowletlge lhal lhls In�ormallon Is complete and accurale;lhal lhe work wlli be In conformance�Yith lne ordlnances and codes o(lhe City of
Eagan; Iha1 I undersland lhis is not a permil, bN only an appllcallon for a permil, entl woAc Is nof lo slart withoul a permlt; Ihal lhe work tivill be i�
accordan�e wilh Ihe approvsd plan In Ihe case of work which requlres a revlew and approval oi plans,
Exteriorwerk authorized by a building pem+tt Issuad In accordance wlth the Minnesola S te Bullding Code must he complated wlthln 180
days of permit iesuance.
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Appllcant's P�lnted Name Applic nt's Signature
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