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1860 Cliff Lake Ct Oct 07 2014 0823AM HP Fax page 1 �,�4 --- Use BLUE or BLaCK Ink ' �,!i��� i �(�- C/�r'�'_ � For OHice Uze � � 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 .`�-� ,� i-'�-�.:-z ��� ' ---� 2014 RESIDENTIAL BUILDING PERMIT APPLICATION � . �y ��; 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. .�—�'�"" X -- �G Z._... ,� x � Applicanfs Printed Name Appllcant's Signature Page 1 of 3 Use BLUE or BLACK Ink r-----------------, I For Office Use � • � l� i (� I C16� Ol ����11 � Permit#: -� � � 6��� i � 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: � � � Appiicant is: Owner Contractor �, �,..w �..n_a4�.�.�,w�.�,���.�.�,.,..�..� � �x.��.�,��_�.��..���.....�_�,u.�,..�m.�-...�..,�.,��„M�,�.����F..u.��.�Ww.���,n..n.. � .��� 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..�.�..�._��� ��� � � �i � �bZ'` ��� �1 8 �5a� ���.�'b�.w � �J Su; e �s� 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# . � �,,�.,T�,�,x��..�...�.��,� �,.a�..�.�K,� __�a ,.�w.�,�..._�..�._,...w��.....,�..�_..x.�.��_r.�.r��_.�M.� ��,..��,,��,�,.�.,,�....a.�a.�.,.r,..,����..�..�.�,.,�.�Y..�,�,xi��. � If the project is exempt from lead certification, please explain why: � � �.,�.._,...v.�_���.�...n._.,.., _. �.w,.�..,.�....�.��..�y...�......W a_.�...�.�,. .�,.�,..��......�,��...,,�.�.�_,.,.�..,.....� 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 -�-�.._.__ e Applicant's Printed Name Appli s Sign ture Page 1 of 3