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� For O�ce Use �
' � Permit#: ` � �� j
C��,1 O� ����� I Perrnit Fee: ��� �
3830 Pilot Knob Road � � �
Eagan MN 55122 � Date Received: �
Phone: (657)675-5675 I �
Fax: (651)675-5694 I Staff: I
I �
2015 RESIDENTIAL BUILDING PERMIT APPLICATION
i� i�'��S� ���� ���Sl�� �osv�c� � �.f �r���-�
Date: Site Address: �`��^ / '� Unit#:
�,�,,. _ ��Name: .,� �111�YY�... .LL ����iL�.,,�u���G✓�wa�.�,.�.�.��....�.�,�,�.,�.. .�.�.Phone: �....���..,.�g
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� (����;r � Address/City/Zip:
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Applicant is: Owner Contractor
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� Description ofwork: Wr�� � J
� Typs o#'l�ark �
� ' � Construction Cost� ������Multi-Family Building: (1'es /No� ��
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� � Company:l,Gt/►t� (�hf�'� ��G�d 1� �hc. Contact:��f �'i'�t r��- ��'-' �
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� Address: �SG'b V'�,�;f��.WJS G�/J � Sulfe °��s/ City: % ��.
CO�1#Y�C'�O#' � /
State:�Zip: Ssy�� Phone: 7G3-S,�� �vn�J Email: ��� �✓�ot�;.I��n,c�w/ ����yJ.
License# /-�G ��� �q.3 Lead Certificate#:
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If the project is exempt from lead certification, please explain why:
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 If yes, date and address of master plan: �
�
Licensed Plumber: Phone: �
Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
Fire Suppression Contractor: Phone:
1V�TF:Pl�►r,s a��'s�ort�`�g tl����ts tha�F y��s�b����cov�s�e�ed t�be p�b��r�##�. P�o�o�s ot'
t��i��orr�►a#�o���y 6e cl�ssi�ed as rron pu����Y y��r pro��ec�re�ot�f�at�wc�r��1 p�r�#th� Ci�,�f�
co�rd�ci�i�!�a a-re�a�►e s�cane��.
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 Gode must be completed within 180
days of permit issuance.
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Applicant's Printed Name Appli s Sign ture
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