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4487 Lakeshore Ter Use BLUE or BLACK Ink r----------------� I For Office Use � . � �� ��� � Permit#: � Tj � � i � � � I J 0 �� I Permit 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 APPLICATION > j �! ,si�� Date: �L I�/�S Site Address: ��� (/����`r�` ` ;�''��' � ���� ��� Unit#: a��..� � vw...-m� ��wo,.�, m...,,, ,�. a.�.,,.., ,�..�.�.... �..�.�,__,_,.v��,w.,�-�..�..,� ..�.u.�,�.��.�..�,_,.�.��_,.��__ . .��,.�...�.W..w.�.�..,�.� �m�.a � (�!l�� � �. . � ' � Name: u �� .���'`�� Phone: � � RsSit��:n#1 � � � Qy��;r � Address/City/Zip: �� . � � Applicant is: Owner Contractor ��_..�, .��,�.�.....a.�.�,�.� .�,a��....�.,..a��..�.�.,�..�.,.�.��.,.,�. - �.�.�.W..,�..a�.�,a.��,...�,��..,,�..��� � ��� ,� Description of work: W�+'z� C� T�� of 11�oric � € � Construction Cost: Multi-Family Buiiding: (Yes /No� � �dw � Company:lJt��' M��h.fi�� L.�''��t�.G�d 1� �h�. Contact: �/..l �"�'� ua� �_�__, .�,��.� � � ,�S�b I� , li/`i I� SUlTe ��` / G� �� � 4 � Address: V G1� ��� �s� City: � � CQtl�l'�C'��#' ' t� � State:�Zip: �Sy�� Phone: '7G3-S.S� .Gn'lJ Email: �°�� � �w�.Irl�au���1''��°Yf. � ; � License# �G �d� 7��3 l.ead Certificate# ���,���,.�w,.�..��a.� �,:�.����..,��,,,..�..,..��,u,,,�.��.���.,,,�,�,�.�..�m....�,��.�... ` If the project is exempt from lead certification, please explain why: - ��...�,�.���..,,�ro���.���.�..,���,��,��..�,._�d���.���.,.��.�,�..,.�,�.�.������..�..,, �.�.� 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? � � � Yes No If yes, date and address of master plan: � i � � Licensed Plumber: Phone: � Mechanical Contractor: Phone: Sewer&Water Contractor: Phone: Fire Suppression Contractor: Phone: �1V�JTE.P�ar��a�d��r�pont���r d:ocu�a�:r��s that you�c���#��e c��s�tl�retl t�o be p��i�rr��rt#cr�. Pa�r��o� � t��i���rma�n r�ay be ciass��ed a�non pt��i��r'f y�t�prorr�Re�pec��fc rea�o�s tfia#w�,�t��err��#�h�'Ci�t� � con�f�de th��i�e �re f�a�e�c��. 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.qopherstateonecall.orq , i hereby acknowledge that this information is complete and accurate;that the work wili be in conformance with the ordinances and codes of the City of '� Eagan; that 1 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� f r<����.�,��,.--- X t. ApplicanYs Printed Name Appli s Sign ture Page 1 of 3 Use BLUE or BLACK Ink r---------^------� I For Office Use � � �L �/� I � Permit#: u � Clt� of ����� � �; � � Permit Fee: ��� � 3830 Pilot Knob Road � � Eagan MN 55122 � Date Received: � Phone: (651)675-5675 I � Fax: (651)675-5694 � Staff: I I � 2015 RESIDE���Al��6UILDING PERMIT APPLICATION�z � ;� �s I r EJ`' N �rx.�� �'!oY� �v�'a C,�-- �' a/'a Date: Site Address: e.1� � Unit#: � � ��Name��u n /��!"� �e���� .v���/'��' ,.�...a.�.��_�,.,.,.�...�..�,.� Phone:��.�.,�..�,�w ...�.ow. �� �..i � �` I�ESltI BM�/ / �.r.�v � QWi��I' � Address/City/Zip: ��� � y��� L�1 < ocr �-t6dr2 cz !.� c�-. ;J .�S�Z� a �, � � � Applicant is: Owner Contractor ��Description of work: J����.�.�..,.,�a.._Q,.,��,wu.���,.��...�.w. . u ��.��.��,,.._.�.r��.�.�....,�.�..,�......� Typ�e a#v�lo�k � � � � �� Construction Cost: / � �' �� Multi-Family Building: (Yes /No� � �.�.,.�..m„�;a.,�.�...,.� . �..,�,�..�,�.�.�.,..�.....,,.,,,m,�,�..� ,.�. � ..�,.4���.�.�,.,.� � �,� /1 �V� � � Company: Cr fS ����0� L"""��`�O 1 ��nc. Contact: ���S � 9� � � �/or�J 2 �/� �y� .��fi - � � Address: ✓�� ��`55�'Ld l�t, G 1` ss� Cify: �'�,�'/�� � � CQl�#t'1Ct=O�' � 1 � � State:�Zip: �-�y�� Phone:��3-'�.56-0�11,/� Email: L��"�1G��Gf��(�'s../`�G��'��, ' �, � License# ��v 6 G�7 /3 Lead Certificate# ' 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? � , S d Yes No If yes,date and address of master plan: � � � Licensed Plumber: Phone: � � Mechanical Contractor: Phone: � � � Sewer&Water Contractor: Phone: � Fire Suppression Contractor: Phone: NOT�':#��a�s a�ad�p�o����docur�e�ts tha#pa�r s�br��t�'e co�s�d�retl!r�b��rb�c i��r��`�an. Pa�o��o�' t�Q�nt'�rt�a��on����e ctassi�sd�s�c�n p�b��i�'y��pro��ls�pec��+c r�asr����at t�oc���t pe►r�t��C�to' sr> � ca��de t�aat� a�e�ra�le,�ec�s, % � CALL BEFORE YOU DIG. Call Gopher State One Calf at(657)454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.popherstateonecall.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 e uilding Code must be completed within 180 days of permit issuance. x (����.� / r�(,{.o�:�,� X �. Applicant's Printed Name App c s Si ature Page 1 of 3