4138 Ruby Lane
Use BLUE or BLACK Ink
r
For Office Use
City of E(, Permit#:
I Permit Fee: 0_0
3830 Pilot Knob Road l
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I Cam,
Fax: (651) 675-5694 Staff:
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: e%1 - !24 Site Address: iz `a
Tenant: Cc_, O;na~G Suite
RESIDENT / OWNER
Name: Phone: O1S'Z V2- tz
Address/ City /Zip: b`"1 C1 L r= ;rye w
Applicant is: Owner Contractor
TYPE OF WORK Description of work:
Construction Cost: Multi-Family Building: (Yes, / No
CONTRACTOR Name: ~"3 r'~ } L L License
Address:
City: L State: N-r)T,3 Zip: S 5 ~y `-I
Phone: V l - 272.. 4 l-t Contact Person:
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:
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.
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 per it; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Applicant's Printed Name Applicant's ure
Page 1 of 3
Sep 30 13 08:55a LS West, Ilc 9522368445 p.6
Use BLUE or BLACK Ink
For Office Use I
PermitM
p My ~ Ea I Permit Fee: r-7 1
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received: j
Phone: (651) 675-5675 i i
Fax: (651) 675-5694 t Staff. i
1 I
2013. RESIDENTIAL BUILDINGI PERMIT APPLICATION
it V-.1
Date: t t 3 Site Address: N. AtJ 11, N N L~ U in t
Name: _ tJt T1 ti n+VIW4.+S ~h ~ 1 i Ovi Phone:
Res identf
Owner Address I City I Zip:
Applicant is: Ow''n'er ~ Contractor
Type of Work Description of work.. _1_e r- og a- r'Gnn7 J6d✓'~/~c~~ihd✓t
r If
Construction Cost: _1~ 3I Multi-Family Building: (Yes / No __J
Company: 2s )P'S4 Contact: )zbA'(el L1 e S•L
Contractor Address: Ze u ke-4ae-, City: LA~@tA
,
Stater -7ip: _d y ) Phone:
License JVS61 ~ Lead Certificate lVff , r ^I Ij
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
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:
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.copherstateonecall.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 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 State Building ode must be completed within 180
days of permit issuan
x • SdH D e-4---- x
Applicant`s Printed Name Applicant` ignature
Page 1 of 3