Loading...
1862 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 � • � Permit#: ��� `�� I ��6� Ol �`"�ll� I Permit Fee: ���� I 3830 Pilot Knob Road � � Eagan MN 55122 � Date Received: � Phone: (651)675-5675 I � Fax: (651 j 675-5694 I Staff: I I � 2015 RESIDENTIAL BUILDING PERMIT APPLICATION � (��,q �C� �'S I��- Date: fi�' ��1�S Site Address: � ��� �lr�� ��c �o� '"� �7� Unit#: .r 6 � � ��,:. � Name:�..K .,�II�Y��_ .._ ����....�N..��.r�i/�..�o��,...,��� .����.�.�,�..�.Phone• �- �.,..._..,._...,..,..�.��.�.�� � Res��i�� � � Q���r � Address/City/Zip: ��� � � � Applicant is: Owner Contractor �.eaw _ �..�...�. �.w..,�„�..,..��,�..�...,.,�..,�a..�.,.�....,..W..�_�� �.� ,�.w M.�,.��.R..,,....m.__..�.._��.�...e....�d�..�W���w.4�,.W..� �,�...�,.�,..� ��,.�.. � ' Descriptionofwork: ��n� � 4f 1��'r�ir l^� � ��� � � � ' � Construction Cost: Multi-Family Building: (Yes /No� ��.:x, p ���.,as�..��.����...��..�,....W,.�,��,��_..�a���.�.�.,��,6.�.�.�,�,�,�..�.�..��,��,.�.�.% � ....�����,���� � � � Company:/,Gt/lt� �{?�� t�'"��G�°1 �hc. Contact: /-�` f Y�t r�� �� � ` 35aa (/,'c.l�1 bw�� �� �U Su;�� '�.�s� c�ty: 1 �� �'� � � GOt���'a�t�0#' � Address: � ( State:�Zip: �Sy�� Phone: '7G3-SS� �bn`�'�� Emaii: ��� � ��.r9�uY���G�v1• , � � £ £ License# �C �o� 7�1.3 l.ead Certficate# �.�,a, �,.�.,�,,w..A��..�:..��,.�..�.�.�,.���.,..,., ,��,.��.�w,,,.. .e,.,._.,...a,.�.��.� _�..�..,..�._�._r.�,.��.,����,,.�.�„�: ..�..�,�. ..,��..�_�„�..,.,...����_.�.,�.�_. � If the project is exempt from lead certification, please explain why: � ��� COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING ~�w����� w � In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? # � � Yes No If yes,date and address of master plan: � � 1 i � Licensed Plumber: Phone: � � Mechanical Contractor: Phone: � Sewer&Water Contractor: Phone: �� Fire Suppression Contractor: Phone. � .�,�IV%OTE:P���a��L�.a^i7�30��1��d��fd��l��s#�'1t3�',y0�15�1�9`.f��COJ?S�t�l'�1'�O��7���1`�to�t� Fc�'c���o�'� , t���r�f�r�a�n���r,�6e cta�s��"r�d ar,s non p��i�����pro�'r�s s�er:�r����ha�t�au�a1�sr��tla�Cl�y t�a �.��,.�.. co�n�l�le t�a�t t�� a��e t�a��c�e��„ .�..�.�,��..�� CALL BEFORE YOU DIG. Call Gopher State One Call at{651)454-0002 for protection against underground utility damage. CaII 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.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� I�r���t,�.� x Applicant's Printed Name Appli s Sign ture Page 1 of 3