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From:ALLSTAR CONSTRUCTION 19529427464 09/03/2013 10:16 #482 P.026/043
3 C~ ~ 1, 3(P lo°l t 3 CQ11 s 3 rat `3 , 3 ~Pi7 5 13,h-I-]
Use BLUE or BLACK Ink
I For Office Use I
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City of Permit
I Permit Fee: 11 5a
3830 Pilot Knob Road
Eagan MN 55122 j Date Received:.
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 1 Staff: I
I ~ I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: ZI 1'013 Site Address:
1~0(~~ VeY~y1I~1DY1 COUP N
Unit#
OW :
Name: Phone:
Resident/
Owner Address / City / Zip:
Applicant is: Owner Contractor
Type of Work Description of work: rL-rouf a~~c1 YL sIc Vin
Construction Cost: Multi-Family Building: (Yes /No
)
Company: ffid71ruC0YlStYtA~i lOl~l MZ1W ahq& Contact;
Contractor Address: 51451109ft-Al St. Wit # 103 City: PIA I n
State: M R Zip: (5`5 Sol Phone: 951- 0 12^ 1'15'1
License #:IS l5 Lead Certificate t#:1y_T1T
i 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:
i Sewer 8 Water Contractor: Phone: t
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 fhe City to
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,-aopherstateoner-all.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 tate Building Code must be completed within 180
days of permit issuance.
x ~luc ~t 741 s+e z d x
Applicant's Printed Name Appli t s Signat e
Page 1 of 3