1860 Cliff Lake Ct Oct 07 2014 0823AM HP Fax page 1
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� j Permit#: ����°�� �
�lty Of���l�Il ���- �� -� � P �, .�� �
� e d Fee. � � �
3830 Pilot Knob Road
Eagan MN 55122 j Date Received: j
Phone:(651)675-5675 � �L'� � ��"� � � � � I I
Fax:(651)675-5694 I Staff: I
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2014 RESIDENTIAL BUILDING PERMIT APPLICATION � .
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Date: � G � Site Address: 1���� � $ �� �� � e� �� �' � ������� `� unit�: .,
Name: ��� T r C� ��'7u j /� �, �- Phone:
Resident/
Owner Address!City/Zip: ��L'
Appiicant is: Owner ✓ Contractor �
Type of Work Description of work: ` �- i
Construction Cost: � �L' �y Multi-Family Building: (Yes � I No_)
Company � c' N�'s , Contact:_ /.�7"�-�G�:.-�-�'
Contractor Address'3 �C 11i1JYf 1 v �''��� City: �/y�2 c l�
State��I'✓� Zip: ��/� Phone: l� Iy 723G 3 Y7 Email:i3�vw�����C:�ri/���s- �
License#:�C�D t�G 7�I/ Lead Certificete#: /��`��1��� �
If the project is exempt from lead ce�llflcatlon, 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 City 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:
Sewer&Water Cor�traclor: Phone:
AIOTE:P/ans anci supporfing documents that you submit are considered to be publ/c Informafion. Poriions of
the fnlorm8lfon may be c/assified as non-public ft you provide specifc reasons that wou/d permlt the City to
conclude that the are trade se�erets.
CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for roteclion against underground utility damage. Caq 48 hours
before you intend to dig to receive locates of underground utilities. www. o herstateonecall.or
I hereby acknowledge that lhis information is wmplete and accurate;ihai the wo�k will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a perrnit, buf only an application for a permit, and work is nOt to start without a pem►it; 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 building pertnit Issued In accordance with the Minnesota State Bullding Code must completed wlthln 180
da perm ssuance. .�—�'�""
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Applicanfs Printed Name Appllcant's Signature
Page 1 of 3
Use BLUE or BLACK Ink
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I For Office Use �
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C16� Ol ����11 � Permit#: -� �
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� Perrnit Fee:
3830 Pilot Knob Road � �
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I �
Fax: (651)675-5694 I Staff: I
I �
2015 RESIDENTIAL BUILDING PERMIT APPLICATIOI�
r� i�/�s I�Ln Ch��� �,k� Cow�- ��.�� l�� s�stz�
Date: Site Address: Unit#:
� � � � � � Name:w.� ��1����� ����_���.,�.���.vi/�.��..���._....A�,..� �,...�,w,�...�.,��Phone: �,..�.,..�w_.�..,�..,�.,�...�...��._�
� I�eSi�l�i��' ` ��� E
; Q���;r � Address/City/Zip:
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� � Appiicant is: Owner Contractor
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� .��� a�,��� � Description of work: W�n-�
� � Construction Cost: Multi-Family Building: (Yes /No� �
§..a....o, P. , � Company.��T�S �h�(,�a� �,�'�1�G�a 1� �h�,�Contact:!-ti'T/.J �v( r�� ��-- ...,v..�.�..�._���
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GO�#P1CtO-t' � Address: � City: �
� State:�Zip: SS���/ Phone: `7(�3-S.j� ,en'�� Email: ��� � �ov�.19e�.oy�(�r����"".�•�-,
� � License#: �G v O� '7�j� Lead Certificate#
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� If the project is exempt from lead certification, please explain why:
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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? �
1
� Yes No )f yes, date and address of master plan: �
s �
i
� Licensed Plumber: Phone: �
Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
� Fire Suppression Contractor Phone. �
, wl��T�:�����a��1�u�r���d�ctr�g���tha�,�o�s�b��ar�e co:r�s��ed#�be�Z����'a��, Ffl�ca�s of R '
� t����s�r�a�o�►r�ay be class��ed a�nz�n���i�c�'y��pro�rz�:s�aeci�'�c r�a�r�s t�a,t�vr�af per��t�:C�ty�o �
�.�_ � ��....._ c���l�cfe�a�i� �re t��ii�s�ct•e�. �,.� �.�..�.�...�,�x.,�.i
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.aopherstateonecall.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 Code must be completed within 180
days of permit issuance.
X �u'f. �r°���.�-- X -�-�.._.__
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Applicant's Printed Name Appli s Sign ture
Page 1 of 3