unit F O�t 2 2014 12: 05PM Crest Exteriors 651-463-8095� P, 7 � �
Use BLUE oP BLACK Ink
� For Offlce Use �~^ �
' � Permit ii: �� I
C�ty of Ea�a� � Permil Fee: / ! t��� �
3830 Pllot Knob Road j `� '�?- �� I '
Eagan MN 55122 I Oale Received: i I,
Phone:(651)676-5676 j Siaff: I
Fax:(651)675•5694
I �
� �.�.-.—_____ ��.�.-.___J
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date:'� SlteAddress; �. i Unit#:
(� �
Name:V , � Phon : �
ResldeYnt/ . � � r
. Q°.�`,ner Address/City I Zip: i
_;;�: :� ,:,,��.. . Applicant is: Owner ConUactor
, '�a'r'�Y�::,�..;: �'r�� 1�^�/
_',v�4.s,r,Y_ �` .
�T�/��-�.�: Descriptlan of woAc;
Of�VI/�O_[ ::
��" �� • Consfruction Cosk� O� Muiti-Family Building:(Yes�/No�
•.�.r-. : . . ..,. Com an 1 ���1 �� f ������L-1 � C �V{ I IC.J
p y; ontact
'G�`"'t�ac�Qr. Address:����� I 1Q__� �\1�f City: ��
-.°.�. :, _ ..- r �
� State:�Zlp-,� Phone: ��mall:l.! S � �� .r��'rl�t
Ucense#:���U�'�-t����L� _lead Certlflcate#:
IF the project is exempt From lead certificatlon, please explain why: (see Page 3 for additional information)
�,\, �, ,.,� . '—,o . I�' �(� �`� � `�� � , � ,
COMPLETE THIS A A ONLY IF CONSTRUC7ING A NEW BUILDING
In the last 12 months,has the Cfty of Eagan Issued a permit for a slmllar pian based on a master plan7
_Yes _No If yes,date and address oF inaster plan:
Licensed Plumber: Phone:
Mechanlcal Contractor; Phone:
Sewer&Water Contraetor: Phone;
NOTE:PI'n and s� ,orhn��.. "�ro-'e'"ts'tliat:"oU su t ��" �lonsi' reG(�`o� pu lic InformatJon. Poriions of
�t�ie irifo�ai��'�lie cra`ssif��,edt �(,• ^:�rov , s .$t�yould permit ilie-Clty�o
, �;,�, •�qn atthQ � � �'�`"
CALL BEFORE YOU DIG. Call Gopher 9tste One Call a�(s51)464•0002 for prolectlon agalnsl underground utlllty damage. Cali 46 hours
befole you Inlend lo dig to recelue locales of underground ulililles. www.aooherslaleoneca�l.orn
�hereby acknoWledge thal thls informalion is coinple(e and accurate;Ihat lhe worlc will be In conFormanCe wilh Ihe ordlnances and codes ol Ihe Clly oF
Eagan; Ihal I undersland thls Is nol a permit,but only an BppllcaUon(or a permil,and work Is nol to s1aA withoul a permll; Ihat Ihe work will be(n
accordance with the approved plan in lhe Csse of work whlch requires a review and approval oF plsns.
Exterinr work autho%Xed by a bullding permlt issued in accordanea wlth the Mlnneeote ate Bullding Code must ba completed within 180
days of parinit Issuance.
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1 ��
Applicant's Printed Name App ca t's Signatu e
Page 1 0(3
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