3646 Burgundy Dr
From:ALLSTAR CONSTRUCTION 19529427464 09/03/2013 10:19 #482 P.038/043
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Use BLUE or BLACK Ink
For Office Use I
City of Eap ; Permit s 5 I -LL
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3830 Pilot Knob Road Permit Fee: 3 OQ I
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Eagan MN 55122 ; Date Received:
Phone: (651) 675-5675 I
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Fax: (651) 675-5694 I Staff:
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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
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