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3646 Burgundy Dr From:ALLSTAR CONSTRUCTION 19529427464 09/03/2013 10:19 #482 P.038/043 3to~o I `3 o4a, 3644, 3b Lkl Use BLUE or BLACK Ink For Office Use I City of Eap ; Permit s 5 I -LL I l 3830 Pilot Knob Road Permit Fee: 3 OQ I I Eagan MN 55122 ; Date Received: Phone: (651) 675-5675 I I l Fax: (651) 675-5694 I Staff: I I Q, 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: V 2 I 10 1.3 Site Address: aLA, - Resident/ -Unit Name: Phone: Owner Address / City / Zip: Applicant is: Owner Contractor pe of Work Description of work: Vic- T, YOLA -Alad Yt - sl d.I Vin Construction Cost: k 000 Multi-Family Building: (Yes Company: IS{7l{r 1SCYIAC._ _L)Yl ~ZIN17901P.YV1Mt Contact: I C{~~(o4 Contractor Address: 5145 Indu►St -Al St Suit 103 City: lU1~lDlfi Pty i n State: Zip: CJCJ soI Phone: 952' C19I 95jy l License t:~~I51~ _ Lead Certificate t Z~~y ~O If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) m 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 s Sewer & Water Contractor: _ Phone: NOTE: Plans and supporting documents that you submit are considered to be public information. rtionso f the information maybe classified as non-public ►f you provide speciFc reasons that would permit the City to CALL BEFORE YOU DIG. Call Gopher State One Catt 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.oopherstateonecalt ora f 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" olu ~t I s+e a d x Applicant's Printed Name Appli s Signat e Page 1 of 3