4162 Arbor Lane
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05/2312014 11:25 Les Jones Roofing, Inc. OAX)9528817009 P.0021016
Use BLUE or BLACK Ink
For Office Use
75
1 Permit ! 1
City of Wan I ~7 J~ I
Permit Fee: ! / I
3830 Pilot Knob Road I r % I
Eagan MN 65122 1 Date Received: / I
Phone; (661) 576-5676
I t
Fax: (661) 6765694 1 Staff: I
2 ! ~a
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: SiteAddress: 4%(o0" 41f.2- "eq--4ttet- A12GOR C"ir Unit
Name: o T E Aemas Assoc JE Ana", hone: Io Sl - 4 o-S- T SSC'
Address / City/ Zip: 4 C C1o AsBO Q : 1- 4mg
i Applicant Is: Owner X Contractor
Description of work: Ks-M o vE p
Construction Cost: , 79 7. y Multi-Family Building: (Yee x / No
Company: sS &&AeS RwFe* /NG. -contact: Gillet sAzwa Zsod
Address: 'i f W. 80 7I/ .0- City: BGO`vtcs.t&z.,dZ
4r
r State: Zip; XfV20 Phone: q5-A - 76 7 - e78/9
License lead certificate WA1- If O 3 9 a = /
If the project Is exempt from lead certificatlon, 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, data and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor; Phone:
Sewer l~ Water Contractor.. Phone:
CALL BEFORE YOU DIG. Call Gopher State One Calf 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.aooherstateonecsll.oro
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, end work Is not to start without a permit; that the work wilt 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.
Applicants Printed Name Applicante Signature
Page 1 of 3