3820 Vermilion Ct S
From:ALLSTAR CONSTRUCTION 19529427464 09/03/2013 10:09 #482 P.002/043
ft2 i MA t 3$te, ~)Wj H2Di X62?-
8 aIA , 3 82b , 829 , 830, ~j $32 i ?j g + Use BLUE or BLACK ink
An.
I For Office Use I
AML I
; Permit g: t 133 4
City of Eajan .
1
Permit Fee:* 152 P-5- 1
3630 Pilot Knob Road
Eagan MN 55122 j Date Received:
Phone: (651) 675-5675 I 1
Fax: (651) 675-5694 I Staff:) I
I t
d 2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: v 2 ( 20' Site Address: _MMI - 3 I &640n CDUtt SOL t 1' f Unit ft:
Name: Phone:
Resident/
Owner Address / City / Zip:
Applicant is: Owner Contractor
Type of Work Description of work: YOof And YL- sl d(m
Construction Cost: tr~ { I Multi-Family Building: (Yes No )
Company: -A&W C 1S IeW MlklAotAft Contact _ A1ft7i1li «i
Contractor Address: 5145 Ir1(~LVISIYI A S$. $UTA 103 City: A2011/ P17t i n
State: Zip: V3.3 I Phone: tJ2' - f~2 1 ~15~1
License F W31151 Lead Certificate NAT- ICAIDL4-0
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
i
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:
I
Licensed Plumber: Phone:
Mechanical Contractor: Phone: p
Sewer $ Water Contractor: _ Phone:
E NOTE. Plans and supporting documents that you submit are considered to be public information. PoWonS of
the information may be classified as non-public if you provide specific reasons that would permit the City to
M^ r s ~rx t M conclude that they are trade secrets.r~~_M_
CALL BEFORE YOU DIG. Calf 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.oooherstateonecall.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 Late Building Code must be completed within 180
days of permit issuance.
x 74kSc31 x
Applicant's Printed Name Appli a s Signatull e
Page 1 of 3