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City of Eapll 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 r Use BLUE or BLACK Ink For Office Use %O I(/� Permit #: l�� &o Permit Fee: /56 - Date Received: ( 7 Staff: 2012 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Unit #: ESIDENT OWNER Name: f///) a / 7Z --(C-0/-1/ Phone: 6zi • .-3 sn ' 9 %0? Address / City / Zip: /93a 1 Lo/3 / L -L ore/ )J g / &/ac0/0 AL / 40/k1 Applicant is: Owner Contractor TYPE OF WORK Description of work: Construction Cost: /) a) co ', (b E 2X Multi -Family Building: (Yes / No) ) Company: Contact: Address: City: State: Zip: Phone: License #: Lead Certificate #: 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: Mechanical Contractor: Sewer & Water Contractor: Phone: Phone: 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 i 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.00pherstateonecall.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 of plans. 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. x rk/fiV ( / / Fe&H /7 Applicant's Printed Name Applicant's Sig ature Page 1 of 3 Use BLUE or BLACK Ink For € ffic a Use 1 ~ Permit I City of Ea qI4 ~S ' { Permit Fee: I 3830 Pilot Knob Road I I Date Received: 2 Eagan MN 55122 l I Phone: (651) 675-5675 Staff:~ I Fax: (651) 675-5694 I 1 L----------- 42 a 2013 RESIDENTIAL BUILDING PERMIT APPLICATION 31JR`O~ r~J pate: lC3 'a2°i -1 3 Site Address: 17a_ ~I~ 1701( 17 a 7 304 1 3a1, 17 3'~ - unit ~M Name: Phone: Resident/ ? Owner Address (City /Zip: I I I Applicant is: Owner Contractor F ~ of Work ;Description of work: ~ cGrca~ V,& Type ; t Construction Cost -75l,' ad Multi-Famiiy Building: (Yes /'ttiio ) Company: ~~1~~1®rn+e\~Qrva-~~ Contact Or✓Q~~ _ i Address: (9o '1 'v:rc + a nn~ ~rkem• Contractor q ~t State: Zip: ~2<23`4~ Phone: l Ja~° `~G,' C O License Lead Certificate 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. Por#!an$ of i the Information maybe classified as non-public if you provide specific reasons that would permit the City to w_conclude that the we trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 tnr h,ol(. clion against underground utility damage. Catl4s hours before you intend to dig to receive locates of underground utilities. I hereby acknowledge that this information is complete and accurate; that the work will be to conformance withthe ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, wid 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 Code must be completed within 180 days of permit issuance. Applicant's Printed Name Applicant's Signature Page 1 of 3 Use BLUE or BLACK Ink �----------------- � For C�ffice Use I � �� I C�4 �� L�o�� j Pertnit#: � I � �; � Ea � Permit Fee: � �� 3830 Pilot Knob Road Eagan MN 55122 j Date Received: j Phone: (651) 675-5675 � � Fax: {651)675-5694 I� Staff: i . . `________________J 2011 RESIDENTIAL BUILDING PERMIT APPLICATION Date: ._�— �� Site Address: I�7� t��vE-�� r'• Unit#: Name: Y' 1�-r'� �%��'rvlj��t�2, Phone:� `�'ZI�f `�� RESIDENT/ OWNER Address/City/Zip: L:�3 Z �LcsG-��L l� �� Applicant is: Owner Contractor TYPE OF WORK Description of work: �d- �- �� d � � `'' S i��.e � � Construction Cos. � � "�' Multi-Family Building: (Yes /No,�� Company: �� ( c�.�c,...!"" �C�S'�� t? C Contact:^�c��,�'( CONTRACTOR Address: �.�� SCYI��rt � S-'{"` City: ��--L �� State: � �Zip: �1�� Phone: �3�-��7C�`� ��Q' License#: C.��-1 3�� Lead Certificate#: !N 6�'�-'��l�� 'Z If the project is exempt from lead certification, please explain why: (see Page 3for 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 tftat you submit are considered to be public information. Port3ons of the information may be classi�ed as non p�blic if yot�provide speciffc reasons that would per►nit the City to conclude thaf fhe are trade$ecrets.' - CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. Call 48 hpurs before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org I hereby adcnowledge that this information is complete and accurate;that the work will be in conform nce with the ordinances and codes of the City of Eagan; that I understand this is �ot a permit, but only an application for a permit, and wo ' ot o start without a permit; that the worlc will be in accordance with the approved plan in the case of work which requires a rev'iew and approv of pl x � �- � l� , � ' Ap ip canYs Printed Name Applic nt's Signatuae Page 1 of 3