1667 Hickory Lane For Office Use
* ' € : ° EAGAN� Permit#:
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Date Received:
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-5694 Staff:
buildinginspections(c�cityofeagan.com L
2018 RESIDENTIAL BUILDING PERMIT APPLICATION #n(c,���y
Date: Site Address:/7.Z /Z� -'
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iName: ° e �1QOG�'t�l�r5 / I Phone: ( [
Resident/ 16 GS 14.-`, ckur7 t _1\`
Owner Address/City I Zip:
Applicant is: Owner Contractor
Type of Work Description of work:
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Construction Cost: TaO Multi-Family Building: (Yes /No )
Company: 60 C lMa tt VI Al rd.St"n11 atL' 9ontact: 4-5./�1/* r or t't( n17
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Address: / 75!3 Fb X 6Cr0 C7L City: / rr i.`ti 9 X, __ /a�
!, Contractor �J `V9
�� 5.50c ' 75-01-87f-e5�16
State: Zip: Phone: Email:
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_'License#: Lead Certificate#:
If the project is exempt from lead certification, please explain why:
No 11-€0. 4 8 : l f— ,`r� 80_siCOMPLETE 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:
,
Licensed Plumber: Phone:
Mechanical Contractor: Phone: I
E
Sewer&Water Contractor: Phone:
Fire Suppression Contractor: Phone:
r NOTE:Plans and supporting documents that you submit are considered to be public information. Portions of the information may be
classified as nonpublic if yodprovide,specific reasons that would permit the Cit to conclude that the are trade secrets.
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.citvofeaoan.com/subscribe.
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.
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 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 if.i-.as.
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Applicant's Printed Name Applicant's -ter