3654 Burgundy Dr
From:ALLSTAR CONSTRUCTION 19529427464 09/03/2013 10:20 #482 P.041/043
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Use BLUE or BLACK ink
For Office Use
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fill j Permit #:1 " 3
City of EaEdn
3830 Pilot Knob Road Permit Fee: ✓ . 00 01
Eagan MN 55122 Date Received;
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 1 Staff: 7~ t'7 I
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d 2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: v 2 I 20' 3 Site Address: s,t ,1^ l "nit
Name: Phone:
Resident/
Owner Address i City i Zip:
Applicant is: Owner Contractor
f Type of Work I Description of work: -foof_ no YL- Si cif
Construction Cost: 3 I O OO Multi-Family Building: (Yes / No__)
Company: ! Iftir C `S'f uchmi MZIwMa Contact: _ Wy ~71 ~fV1
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Contractor Address: 1514fJ1 W1~ ' JI f 1-A~ t' S. # city: M~~fi 1'
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State: MR Zip: 553VI Phone: 951- 941- L494
F_ License Lead Certificate f"I
1YT- 10gloy -0
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:
r Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to.be public information. Portions of
the information maybe classified as non public if you provide specific reasons that would permit the City to
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.aoaherstateonecall.oro
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.
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App icant's Printed Name Appli t s Signal e
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