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1901 Sapphire Pt Use BLUE or BLACK Ink I For Office Use 4 City O1 ~11 :::ee E :l_i 3830 Pilo t Knob Road Eagan MN 55122 Date Received: Phone: (651) 675-5675 Staff: ? t Fax: (651) 675-5694 2009 RESIDENTIAL BUILDING PERMIT APPLICATION Date: t Site Address: c'1 "L1 ' vl Tenant: Suite RESIDENT / OWNER Name: Phone: 01 S'3, -5'1 \-2- Address/ City / Zip: fit.-~~; rr w d Applicant is: Owner Contractor TYPE OF WORK Description of work: Construction Cost: Multi-Family Building: (Yes / No CONTRACTOR Name: License 2 5 Cc>ZS's~-12 Address: City: V 1 \ State:-NE'D14 Zip: S 5 'I j -1 Phone: 9 12 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. x Applicant's Printed Name Applicant's ure Page 1 of 3 Sep 30 13 08:58a LS West, Ilc 9522368445 p.11 Use BLUE or BLACK Ink r.___-_--__.---------, I For Office Use ` I Permit biq of Eakan I Permit Fee; `~Y 1~j Z 3830 Pilot Knob Road l----- I Eagan MN 55122 Date Received: I Phone: (651) 675-5675 l I Fax: (651) 675-5694 I Staff: I { I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: O~~ 3 Site Address: ~ SSol l~qq ~I r 1 nr unit x-11 Name: T 1Zy 1_V~^'rr~6:+S h I Phone: Resident! Owner. Address / City i Zip: Applicant is: Owner Contractor Description ofwo6 1 e, Ar~ 0f± a- jre-VaS &;1UP6 0 a Aru~~~S Type of Work 1 Construction Cost: q d ~ le -1 3 Multi-Family Building: (Yes I No Company: ~5 l r/'~ 1 C'i Contact IZAAArd X514' n f' • ' Address: , b 1 Ze it evrur- City: 4A 1 0 Contractor 1 ~ 1 2 State: I ~/~"jJr p: Phone: 61 ~ - 1 - 4 4 License #alt,~ 1 Lead Certificate #.A) - D 6 J If the project is exempt from, lead cedification, 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) 454-0002for protection against underground utility damage. Call 48 hours before you Intend to dig to receive locates of underground utilities. www.gopherstateonecall.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 cassof work which rehires a review and approval of plans. Exterior work authorized by a building permit issued in accordance with the Minnesota State Bull ing Code must be completed within 180 days of permit issuancI- x ,SA h W I-19" x Applicant's Printed Name Applic is Signature Page 1 of 3