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For Office Use I
tJ I I
I Permit _ ~ I
City of Eap I
1 Permit Fee: E-5 9' 9 • R S ,
3830 Pilot Knob Road I
I
Eagan MN 55122 Date Received: q - 1 l$ 1-3
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff:
I I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: ~t Unit
Name: C7j®~'~ Phone:
Resident/ J / .
Owner Address / City / Zip: S, d r~. a y f
Applicant is: Owner Contractor
Type of Work Description of work: )ec-- roe)
`
Construction Cost: 0 oo (CIO
Multi-Family Building: (Yes / No )
Company:
J
0 Contact: F_r, `e-C,0,(,,
Address:
Contractor ~ 7 r- J~ ~~4 ity: 1 16"iq
State: P Zip: ~3_S_ 3 3 3) Phone: > - 63
License Sc, 6M 63~;_ Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information
I {
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: j
I
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 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- 1
before you intend to dig to receive locates of underground utilities. www,gopherstateonecall 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 Code must be completed within 180
days of permit issuance.
x`d C k6 O/,-) x
Applicant's Printed Name Applicant's Signature
Page 1 of 3