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1855 Cliff Lake Ct Oct 07 2014 0825AM HP Fax page 10 Use BLUE or BLACK!nk � For Ottice Use � � j Permit ii: ��� j Clty of E��aIl � � � � Pertnrt Fee: �� � 3830 Pilot Knob Road Eagan MN 55122 j Date Received: � Phone:(651)675-5675 I I Fex:(651)675-5694 I Staff: I I I . L���������.�������J 2014 RESIDENTIAL BUILDING PERMfT APPLICATION � � Date: �� �° � Si1e Address: � g�� l '�Y� ���� ��� 7 `-`�•'� '� � - �_ Jnit#: J !. �[ a Name: ��.���� ��=--- �r:,��?�''a� f':: ��. �'f-,. Phone: Resident/ Owner Address 1 City!2ip; ' �� �- Applicant is: Owner ��Contraclor ; Description ot work: � � u-- -•- <�'La � �'"•v Type of Work I � F� Construction Cost: �7 �Z� / '� � Multi-Farnily Building: (Yes ��'� /No� ' �,• f'' r' f i` �..._ � Company��. ° . �����u�i'�a� �'�.`7`I'���.-�s. Contact: 1`�����.��..� �- Address:.�" � R `�'�=-< ya-.�-r.`�' �r+� �:�- C1�' � COI1tf�C#O� -L l��� 1I � �!' , „�3..:.. City: ��f sl`�+%�,:a� �r �' , State!��`�'� Zip: �� �r� Phone: �a f?-��'s�'��� ��7 Email:�r`,4::.�.r�.�•n����;'�`�=,s9���c'''ra�;:��. "� � �.^ License#: ��-��� 'r��.� Lead Certificate#: �'�''�°''��a�~'f�`""4''� - 1 If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months,has the Clty of Eagan Issued a permit for a slmllar plan based on a master plan? _Yes _No If yes,date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewe�d�Water Contractor: Phone: NOTE:P/ans and supportlrtg documents that you submlt are considered fo be pub/Ic lnformation. Pvrt/ons of the/nformat/on may be classifled ss non-public if you provide specific reasons that wou/d permlt the City�o conclude tha[the are trade secreis. CALL BEFORE YOU DIG. Call Gopher State One Call at 651)464-0002 for protection against underground utilitydamage. CaU 48 hours before you intend to dig to receive Iocale5 of underground utilities_ www. o herstat�onecall.or I hereby acknowledge that this infocmation is complete and acwrate;thaf the work will be in confotmance with the ordinances and codes of the Clty of Eagan; tha: I understand this is nol a permit, but only an application tor a permit, and work is not to start without a permit; that the work will be in accordance wlth the approved plan in the case af work which requires a review and approval oi plans. Exlerlor �horized by a bullding permlt lssued in accordance wlth the Mlnneeote S1ate BuIlding Code must�je completed wlthln 1 BO da perm! ssuanca ��-°• .. `�' ' -......� ,f°� `g . `r,�z ���,,; � x ,.�.���`�-�- �_...�J./� �_•:�°' �"_,_.�, -..,. _ , �..�,:... 3r x �--- Applicant's PriMed Name Appllcant's Signature , Page 1 of 3 Use BLUE or BLACK Ink r--------^-------� ( For Office Use � I � �� 1 C��TT o� j����� � Permit#: � � � � i� � Permit Fee: � �� � 3830 Pilot Knob Road � � Eagan MN 55122 � Date Received: � Phone: (651 j 675-5675 I � Fax: (651)675-5694 I Staff: I I � 2015 RESIDENTIAL BUILDING PERMIT APPLICAT�I� �SIZ� Date: �Z ��1�S Site Address: � " `�s C�!�l� �,^� �ow�'1 ���" U t#: �,.�.�...._,. � Name: ,., ���l�f'Y"� � ��m���.,�.,..�._.��.oi/(_,.5..�.e..,k�..�..�...a,,..d..u.�...a�., Phone: ��....�.....�.�.�.�.�.a,..� � Ft�s�it��� � � � Q���;r Address/City/Zip: �4�', � � Appiicant is: Owner Contractor �,_ .,.�.,w..,�,. ...�. .,.�.d�.,.��m....�..p�,.n �..� ,.��w...�..,��._...,_.��.��..�..�...�.n..r...w. ��, ��_.�.��..w.e.;� �� .� � Description of work: W ►'� � T�� af V��ark � � Construction Cost: Multi-Family Building: (Yes /No� � �.. �,._,., .� �,.,..��, ,,��..w....�.�._�� � tl FO V � Company.�/,t�� �{?G�� ��G��1� �h�, Contact: ��-T �U( u� � � � ��'^ ��� � � � /� �i/ SUlT e ; Address: �S� �G���'� � �s� City: Co�a�ract�r � � � State:�Zip: SS��� Phone: '7�3-S,S�� .vn''�� Email: ��-� � /�Ja�?u���Y�clovJ.� � � , � License# �G �O� ��.3 Lead Certificate# ���,���_�.,..��.�....�.w,_..��.�.....,�,�,.�,�,,,,..,.�..,,. �,._a. .���_.,rM._m�.�...�..�,�,�..��,�.�.,_.._ ,�,._,.,..�v......a��..��u�._,�...,..�..�_.,.�....m._�.,,�w�,..,��,.�..�.�..,���._ .,�...�,._.a _ _ . . _ w � � If the project is exempt from lead certification, please explain why: � � .�,.�....�.�.�.��za�. . ,Wx��.�.��... w_.d�.�.,..,�.�.�..����_�. .Y,.....�,�,�.,...,.eW�w,,.��..�.�,�.�...�. --��.�..�..�.�.,..� COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING � � In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? g � � Yes No lf yes, date and address of master plan: � t i � Licensed Plumber: Phone: � Mechanical Contractor: Phone: Sewer&Water Contractor: Phone: Fire Suppression Contractor. Phone: �� IV�Tf.F����s a�a�1 s�t��r��'��aEo����s�a�yFo�s�ab�a�e coa�s�ered t;�h���i�'ar�°t�, Pa�c�r��o�' j � ��+i��or��rt���r�e classi�d as non pt���c�y�o��ro��ec�r��rs.t�a�t�v�1 per��t�re�tra�h � �_ �.. co;n��fe f�M�f t� �.�e t�-ade sec�e�> , _�. CALL BEFORE YOU DIG. Call Gopher State One Cafl at(651)454-0002 for protection against underground utility damage. Ca1148 hours before you intend to dig to receive locates of underground utilities. www.aopherstateonecall.org I hereby acknowledge that this information is complete and accurate;that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a perrnit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Exterior work authorized by a building permit issued in accordance with the Minnesota S t Building Code must be completed within 180 days of permit issuance. �/ � X �Lf�f jyf.���t'°E'�a-�` x 6 Applicant's Printed Name Appli s Sign ture Page 1 of 3