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Permit tr9°
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Permit Fee: /‘6 (t___
3830 Pilot Knob Road
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Eagan MN 55122 Date Received.
Phone:(651)675-5675
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Fax:(651)675-5694 Staff:
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2017 RESIDENTIAL BUILDING PERMIT APPLICATION / () / Gt2-- -D .Q,
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Date: i $,---'11 Site Address: .' /,..i. ,, -,,, .i,,.„, ,,,,, Unit ff:
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Name: f,J iC1;., 0 1 i !: _;- 1 ,Ji..A1 1 (0 1 rk-- ‘i• : ;E i I L.,- Phone: _
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Owner ; Address/City i Zip: //
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Applicant is Owner Y\ Contractor . 1/ 37 ,
I ' Description of work:
Type of Work t
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: 1 t'5 t -f -, CC
Construction Cost: ..._ )l•-,,, ,._/'_„. ./ , Multi-Family Building:(Yes ,..>:,%, /No )
l Company: -::), hA ' ,, Ci ....-.)--th.. tc LILA )
i Address::r;,2,-C-C, I--l.,„,,Wilii"XL/1(..14i -'.: (.-. 2:- r 1-;t•-`city: r ,i 4,..,41./X) ,II
Contact: i 'L 1 , L,(,..ii ,,, -1
Contractor -
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1 t State: - t'-,)Zip: l---Ti-;1.)(i- ''"'C't Phone: I/„,l,„ ' Email: 1,;) ,t„,,„"„ 14I„(_,l"I 1,1 ,(:,,c,&- k.,1-3(.0:V,1171,(Ph.,1 1
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License it: I'''''i Lead Certificate#: p,,,,J
If the project is exempt from lead certification, please explain why:
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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:
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Licensed Plumber: Phone:
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Mechanical Contractor: Phone: I
Sewer&Water Contractor: Phone:
Fire Suppression Contractor: Phone:
NOTE:Plans and supporting documents that you submit are considered to be public information. Portions of .
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
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.gopherstateonecall.org
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 vvith 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 State Building Code must be completed within 180
days of permit issuance.
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Applicant's Printed Name Applicant's Signature
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