1663 Hickory Lane r For Office Use `/(�
t, i�....... ..... Permit#:
i E AG A N
Permit Fee:
I EceivE Date Received: 7—7
3830 PILOT KNOB ROAD EAGAN, MN 55122-1810 ,,,,,,��rr opt,/
(651)675-5675 I TDD: (651)454-8535 I FAX: (651)6 Ht'R Staff: _
buildinginspections( cityofeagan.com ' 7 2019 J
2019 RESIDENTIAL lif i --. - _. MIT APPLICATION
L-� -7 / /6s1 / /
Date: 1 — 17- 17 Site Address: /�-5/ �` C rY�A�� �C Unit#:
ir
Name: WOO c13 al Z l r►1e 0V'ta Assoc ,oi V(711 Phone: 657 - L/51-73Y?
Re tleintr J 1 ! ,`C ICOI` I ` �' Ect Q ....C5 ICZ.*
Owner Address/City/Zip: 9
Applicant is: Owner X Contractor
Description of work: ' `. ' "`'QY Mar ar cr CIh Di r'e, lac i;°
Type of Work J
Construction Cost: ` /a Multi-Family Building: (Yes /No____)
Company: Bc,rNot ° l D`07"si-ern C-Q' #t'a. ,1'7y tact: Sftre AOrr►1q.tI
Address: / 7 5-73 froX 601/b CI- City: Fovel-t, h5 Irli
Contractor f'641.- x368
State:ti N Zip: 55°0/11 Phone: d 59 ` Email:
License#: p ` ` 0 Q 6 1 Lead Certificate#:
If the project is exempt from lead certification, please explain why:
NO /0
01,;i1 sfr _ a 11 A00P`h
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:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
Fire Suppression Contractor: Phone:
NOTE:Plans and supporting documents that you submit are considered to be public information. Por ons of the information may be
classified ag non-public if you provide speak reasons that would permit the City to 00nOttgie hat they 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.citvofeanan.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.aooherstateonecall.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 approva of ans.
x Srfee t i O r&Pail it ii x /�
Applicant's Printed Name Applicant's Signat re