3600 St Francis Way E
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Oet 2. 2014 12:05PM Crest Exteriors 651-463-8095 P• 2
Use BLUE or BLACK Ink
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� For oftice Use �
' j Pemi111F: ��� / /� j
City of Ea�a� I peRnit Fee: ���� �
3830 Pilot Knob itoad � / �
Eagan MN 56122 � Date Recelved: / �
Phone:(6b1)676-6676 I i
Fax:(6b1)676•5694 I Slafi: 1
I ►
����.�._�.-..-..._.___�___J
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date:�� Site Address: � Unit�:
Name:CI��Zn����a t l�K.� PhonA:lYJI 1 J��� (11,��
Resldent/ I �
Owner Address l Cily I Zip: C
Applicant is: Owner Conlraclor
Type of Work Descriplion of work:
ConslrucGon Cost:��� b� MuIG-Family Building:(Yes�/No�)
Company: J �l��J, L��_� Conlact: f--lit 1 1�/
Contracfor Address� ��] � l�I� ���- Cicy:
State:�Zip���� Phone: ��mail:�Q,S��►]�S r�i�,rc�-r�.t
License#:������ Lead CeRiflCate#:
If lhe project is exempf from lead ce�tiFication, please explain why: (see Page 3 for additional informalion)
� , �
COMPLETE THIS A A ONLY IF CONSTRUCTING A N�W BUILDING
In the last 12 months,has the Clty of Eagan issued a permit for a similar plan hased on a master plan7
`Yes _No IF yes,date and address of master plan:
Llcensed Plumber: Phone:
Mechanlcal Contractor: Phone:
Sewer 8 Water Contractor, Phone:
NOTE:Plans and supportln,g,docum�nts thRt you subm/t ere constdgred!o be pub►lc.lnformetion. PorfJons of
the jnformation,may be classifled as�iion public if,you provide�peclilc reasbns fhaf would pe►m/t ihe C/ty to
� ��'con�lir�e that�[he are trade secreb, �
CALL B�FORE YOU DIG, Ca�l Gopher Slate One Cell al(661)464-0002 for proteclion agaiml underground uliliry damage. Call 48 hours
be(are you inlentl lo dlg lo retelve Iocsles ot underground uGlilies, www,vooherslaleonecall.oro
I hereby acknowledge lhal Ihls In(ormatlon Is complela and accura�e;(hat Ihe work will be In conformanGe wilh Ihe oldinances end codes of the City of
Eagan; Inal I undelsland lhls IS nol H pemlil, bul onty an applicalion for a permil, and worK is nol lo slarl withoul a permil: Ihal Ihe work will be in
accordance wilh Ihe approved plan in Ihe case oF work which requires a revlew and approval of plans.
Extarlorwork authorized by a bullding permlt IssuAd In accordance wllh the Mlnnesota Slate eullding Code must be compleled wilhin 180
daye of permil IseuanCe,
x ���\�� � � x ,
AppllcanPs Prin ed ame9 Appli nt's Signature
Page 1 of 3
For Office Use 1
_
F....di: /.5-V 7.f-- 71
EAGAN ,
POMA Foe; 6 -C,*, - —7
Date Reservist 1
3830 PILOT KNOB ROAD I EAGAN,MN 55122-1810 I
(651)875-5675 1 TDD;(651)454-8535 1 FAX(BSI)675-5604 Staff il
13.;.1411:121NR9tratiCtri$etAjearrAtilitlft cry11 .... ... ...4
2019 RESIDENTIAL BUILDING PERMIT APPLICATION
Data. Site Address: 36,t)0 St• I:(4 - ORI Unit It
i
i
, I NaMe: '--- - i '`i.-: 1 ( 4... . ,I. . - i`k 4.)a, Phone: ‘‘1 -0) ‘s ;
; Resident/
Owner j Address i City/Bp: J(c,(--)4.:7) A — r1^", 3 N • F. 4-.1..-, (...." ),.-•
Applicant is. Owner .,\-C. ontractot .
Description
ype of 11M7rkF--- ---7 --
T __j...„... j
lcAmstr0000ncost. ....,_i , __.. 0 C.-;' -2-- Multi-Family&Ming,(Yes I No
t
Company: -71-1-Z. tc-0 0 .-4, v--5, '" Ai 1:...- k Contact 0 t•1/4,--- C rsr-ei tel.6Cr.4.,t--• 1
Address ¶1 10 c .., 4,:i kk,,, ;..IY`--v-- 6 iv A ikd -'" - - CitY. /...,4,k -C..-
Co actor , 1
, i-3- v 1
SU"' /-‘ 4" ZIP S -.1:.LY. z . Pohe. i-S /- / ? / • Email. ,-5 I A.- t''- -j -; f' .1,, s Al %., ;2 .c
1 License ii. . - L i s'.. t* i q Lead Certificate*, 4 1 11 i _ 4. ;)-.) 4 - i
_
..„...--
If the project is exempt from feed certification, please explain why:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A pIEW BUILDING
In the last 12 months,has the City of Eagan issued a porn*for a&Snider plan based on a master plan?
_ —
Yes No If yes,date and address of master pain:
Licensed Plumber: Phone:
Mechanical Contractor Phone:
Sewer&Water Contradkor Phone:
Fire Suppression Contractor Phone:
MOTE:Plaid and suppolIng documents*Wyou subeditors coneldensi to be pubic behtmellon. Parbene ofI to e taletatelitsh my be
dowelled es non-oublo ff re Feet*'mite meow mat weekt pelmet the aly Ilis ononaltidt MP"WV are bees ooteete.
You may subscribe to receive an elects:Mc notification from his City of proposed andminces by Mph*up for as amain matt on the Ctrs
webs's'at itwri cit comistdiscgat
Exterior work authorised by*btaldhig pima issued bt w000rdwitati with the tithwateota PA*Building Code must be competed linden lid
days of permit issue.
raL.BEFOOM YOU QR. Call Gopher Stale One CM at(551)4844002* prolix:bon against underground utility&maw Call 48 hours before you
intend to(%)to receive locates of widow:mind utilities 166167001erS1ateOreciaLQU
I hereby acicroitedge tat the irdocniation ie complete end eccurees:tisk the work will be in conktonance wth the ordinerwas and codes of the Cky or
Eagan,that I understand tie W not$pent*, but only set appicadion for a permit, and work is not to start withoit a pent*,that the work.wit be in
ecowderve rah its approved pan in the cruse id wort which requires a review end approved o.±01204,_ __
A1.4)1.:„..,-, Sv-.....-T.4 .. 1.—
Applicantle Printerd Name Applicants Signature —-- -—
•