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
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I For Office Use
` I Permit
biq of Eakan I Permit Fee; `~Y 1~j
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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