1862 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 �
• � 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
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2015 RESIDENTIAL BUILDING PERMIT APPLICATION
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Date: fi�' ��1�S Site Address: � ��� �lr�� ��c �o� '"� �7� Unit#:
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� Res��i�� � �
Q���r � Address/City/Zip: ���
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� � Applicant is: Owner Contractor
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Descriptionofwork: ��n�
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� ' � Construction Cost: Multi-Family Building: (Yes /No�
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� � � Company:/,Gt/lt� �{?�� t�'"��G�°1 �hc. Contact: /-�` f Y�t r��
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GOt���'a�t�0#' � Address: �
( State:�Zip: �Sy�� Phone: '7G3-SS� �bn`�'�� Emaii: ��� � ��.r9�uY���G�v1•
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£ £ License# �C �o� 7�1.3 l.ead Certficate#
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� If the project is exempt from lead certification, please explain why:
�
��� COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING ~�w�����
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� 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.
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X �U�f� I�r���t,�.� x
Applicant's Printed Name Appli s Sign ture
Page 1 of 3