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1854 Cliff Lake Ct Oct 07 2014 0823AM HP Fax page 4 Use BLUE or BLACK Ink r----------------- � For attice Use � � j Permit#: l��lQ V`f' j Clty af �a�a� � .r�— �� � � Permit Fes; J �,�� � 3630 Pllot Knob Road Eagan MN 55122 � Date Received � Phone:(651)675-5675 � � FaX:(651)675-5694 I Staff: I i I v��..�����������-��J 2014 RESIDENTIAL BUILDING PERMIT APPLICATION Date: A�13P� �.' � Site/+ddress:��� � � �. 1��!I�St1 ��`� ��� `-') �_ �����n: � S �n" I Name: ��0�- , �'���-`-=�• �L��� �; �. �� Phone: Resident/ Owner Address/City/2ip: ' �i g'7Y7� Applicanl is: Owner �F�'���Contractor ,�.-.;__. '�` Type of Work Description of work: �- � �, � � '�1� /G L� 4r ��� Construction Cost; 5 � Multi-Family Building: (Yes �''�/No_� Company;,�°'`H " �'r`-� �;1��"-.�c�,�t,a�'1����;Z�''�da�c;s�:� Contaci: �w �:�7�e,r-�•:�..-.,-. ContraCtOr Address:�'� ` Oo'a���d�,;�: `.av" :^ ;�.�'�� City: �f�1'�-''J r.�� State���'��,F Zip: �')�'• ��I Phone: � P`����� ��,�Email: aa%�;��..��.`��r.�`c°�rF .'� ���.�f�- �icense tt: t=r�.= �'��'?�'�'�`,� Lead Cehificate#: �'�f�=��`-�>-�'-i� � � If the project is exempt from lead certlfication, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last t 2 months,has the Clty ot Eagen iasued a permlt tor a similar plen based on a master plan? _Yes _No If yes,date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer&Water Contractor: Phone: NOTE:P/ans and support/r�g document9 that you submit are cons/dered to be public informaflon. Pprtions of the intormatlon may be classified as non pub/ic ff you provlde spec/f!c reasons that would pe�mlt the Clty to conclude that the are trade secrets.. CALL BEFORE YOU DIG. Call Gopher State One Call at 651 454•0002 for rotection against underground utilify damage. Ca1148 hours before you intend to dig to receive locates of underground utilities. v:tivw. o herstat�cnecall.oc I hereby acknowledge that this information is complete and accurate; that lhe work will be in conformance with the ordinances and codes of the Clty of Eagan; Ihat I understand this is not a permit, but only an appliCation for a permit, 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. Exterlor�horized by a bullding permlt iasued In accordance with the Minnesota State Building Code must be completed wlthln 180 , day�"�perm ssuance. ,._„_..Y---�-�-°�,w-'"T'° f � ; : ___, :�-_ � ., g � �,p.. .. _ . �, ,`,,..�..e..__.:�. X_ _ �.z..`c---�_,._ �,�. .�jj'"J-�-..� x ._ _ �..W..,�., Appllcant's Printed Name ApplicanYs Sienalure „ Page 1 of 3 Use BLUE or BLACK Ink r----------------� i For Office Use � � � ���� , C�b ol �� �� j Permit#: � j � � � � �� � � Permit Fee. 3830 Pilot Knob Road � � Eagan MN 55122 � Date Received: � Phone: (651)675-5675 I � Fax: (651)675-5894 � Staff: I � I 2015 RESIDENTIAL EiUILDING PERMIT APPLICATIO� Sfj�-�. ' /,��/ �U�� �- Date: t�' ��/�S Site Address: � ��� �l1 �� `-''""^G �O� ✓ Un�t#: �,.�, �_w �. t Name:W.. . /) �l��1' _ _.._��m��a_..._..��Gi/{,s__�..�..v�. ..�._,,.a �,_�..�....�...�Phone:�� ..,_.�.a�..,�.m.�..,......�..�_._� V g � Re���d��1 ` � � Address/Cit /Zi .5�� � C111ifiiPl' Y p� � � Applicant is: Owner Contractor � �. .�, � � Description ofwork:�.���-�v ��a�..�...�.� �w�_,�,r��,e�......� _,_,.._.w�...�__.�w.��..�..._...,.,�.��.. . Ty�B CY�f 1��1"k � ��� � � � ` Construction Cos#: Multi-Family Building: (Yes /No� ��, ���,��..�,.,�,.���_.�....����,,�...,��.,,�,...�..�,�.,,..�.,.�..d..w,.��..,.�»�,....�.,d�,�,,..�,�.,,.�,..�.�..,��,,.�,,,,�...�.� .�..w.�...,_.v.,.�,,.�.,.,..�.�.,.��a�,� � � Company:J,t�� �Vtfi�� (�'��GTa 1� �hc. Contact:��f �� ��- �"" � a u�,_ �/y.� � � Go�traetor � Address: JSGrb v'�.� bwx-� �� � Su,�� .�s� c�ty: , V/ � � � � SS,��,� �J � � � State: Zip: Phone: �7G3-SJ�,Gn�.� Email: ��J � /or��J9,�in,c�����rJ.� � � � �� f � � ' � License# �G °�� 7�1.3 Lead Certificate# �,.��. �.....�.a..�e�.s...���..�,,...�., � �..�u �,..��.,..,M�. �.�.,.. �,_.��...��....�,,x.._�. -„�.u�..�, ��.�..._...� ..a�,�._,,�,..,.���_„_.,�,�W.�,�..«�..�..�...�.r_..._..� � � If the project is exempt from lead certification, please explain why: �,..,� - .�.m....,�w..�_..m�M .�_�.��.... . ..�,.... �.n�,��..�...�...� .._�_.�_..�.v..�_,��,.,w,..,..,. _�.M��..,�...,.._�� 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? a � � ; Yes No lf yes, date and address of master plan: � 1 � � � Licensed Plumber: Phone: � Mechanical Contractor: Phone: Sewer&Water Contractor: Phone: � Fire Suppression Contractor Phone ¢ ���.�IV�T�:F���a��l s�t�no���c�[a�r.t��e�a�t,�t��#yo�s�#t��a��eoa�s�re�►t�tlb�pu���°�#ar� l�o�'o��o�' _� � �����orr�+������r be�1a�s��ed a�nan p��b��1�'y��r Fro�i�e s�ec�r����o��tf���a�d pert��t�C�t� � e�rnz���l�t�t�i�ae a�re tra��c�e#�: CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.qoaherstateonecall.orq 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 permit, 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 Gode must be completed within 180 days of permit issuance. X �Lt�f T YP�(0�++�a�.�r-�' x `�—..t � ApplicanYs Printed Name Appli s Sign ture Page 1 of 3