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4) SEWER V " arc og WAN PERhirf
37111 ,Rsosil PERMIT NQ.:
.mow, #414 U12S DATE: .. Zpoinei 44 ° _ No. of Units:
owner:
Site r (..' _
IUr11I1eC ! t ` S-
I agree to eereply with the City eh loges Connection Charge 4 Q i,
Ordieeeees. Account Deposit:
Permit Fee: 1 t' '1(1 t,
Surcharge: ': p ►cF+a►ge:
By Misc. Charges:
Dote o Insp.. Total:
Insp.. Date Paid:
�- �_
Use BLUE or BLACK Ink
r
I For Office Use
I _ v I
City of EaEdn , Permit#:
J l~ a I
Permit Fee:
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675
Fax: (651) 675-5694 I Staff:
I .T I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: D l Site Address: glAY141 &M Pt- y40j y` C 11 Pt Unit
Name: I \ 1,PGL°C_L I s7 Phone:
Resident/
Owner Address / City / Zip:
Applicant is: Owner contractor
Type of Work Description of work:.-,/~ /+e /-G y r
Construction Cost: Z 7~y~ Multi-Family Building: (Yes No
Company: D ~h •l Vole 1 "l Contact: L A5 e
Contractor Address: 1ey ev` City:
r
State: Zip: S~f ~3 3-7 Phone: LJI~ -
License 01-V ? ~FG 6 4(_'7 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. Portions of
I the information may be classified as non-public if you provide specific reasons that would permit the City to
( conclude that the 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.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. l
x 04-11 L! 7 jL° x
Applica 's Printed Name Applicant's Sig ature
Page 1 of 3
Use BLUE or BLACK Ink
r----------------�
I For Office Use �
� � Permit#: t ��� �
City of �a��� ; . ;
Permit Fee:
3830 Pilot Knob Road I I
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 � I
Fax: (651)675-5694 I Staff: I
1 I
2015 RESIDENTIAL BUILDING PERMIT APPLICATION
�',�q� Yr gZ �rsf� r�
Date: l Site Address: � Unit#:
� � �
�`
�����.� � � �� �,, Name: ��It�����--� ��� Phone:
�`�Resident/ �
� �Ow�er � _' Address/City/Zip:
�� � ���� � �
�,�.� �` � �`�����' A licant is: Owner �Contractor
�.. .: ��. ,����. . .�,.:� Pp
� � � � �
� ��� ' n
�� � Description of work: �� �" �t�/�.
�,�TYp� of Work ,�
��..,�� g�:�„��� ��,�� Construction Cost: Z'�d�p Multi-Family Building:(Yes � /No )
�� ��� �� �; � ..-„
� � ���-� , ' P Y'�71T�/-�IZI��—�G�.--
, � � Com an � OL � Contact: ��
�� � ���
� ,�� � , ��Sr �i�t�tu�Y> C�' _c�ty: ��/�«t'�'�.
�� 3� xt.� � ��: Address:
Contractor - �- ,
� ., �� � �. State:��Zip:��� Phone: -�`G� ��maiL
�� �� �;
� �� ;����. t License#:�3����� Lead Certificate#:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTIING 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? �I
_Yes _No If yes,date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
� NOTE Plans antl supporf�ng doc�uments that you submit are*co�ns�%red to��e pub/ic�nform�:t�on� ortrons of�
��the rnformat or��raay�be�c/ass�fieal as n�o�i publ�G rf�you��ro�fde�sp�eci��ic reasort��fh�f wou� Fe r�# ��fo��;
��
��;_ ; ���.�.�` ��:� �.�� ��x . � �conclude�tha#=the ,TMare,�trade.seci ets.��...��a >��4� �;� ,�,.., ,�; -�'�
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.popherstateonecall.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 S�tate Building C e ust be completed within 180
days of ermit issuance. �
���s
x �.
x
ApplicanYs Printed me App icanYs S ature
Page 1 of 3