3762 Vermilion Ct S
From:ALLSTAR CONSTRUCTION 19529427464 09/03/2013 10:11 #482 P.011/043
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I For Office Use I
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City of Eajan i Permit ` ?213 477
Permit Fee: 13 Of .
3830 Pilot Knob Road 22
Eagan MN 55122 Date Received: 4A i ~J
Phone: (651) 675-5675 1 I
I
Fax: (651) 675-5694 1 Staff: L 12
2013 - - - - - - - - - - - - - - -
d 20113 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: v 2i 2oIJ Site Address: _31"49)- 31 DIP V=MDY1 sWlkJ12 Unit#:
Name: .n,..-:...~~.. Phone:
Resident/
Owner Address / City / Zip:
Applicant is: Owner Contractor
' of Work Description of work: roof -A
Type
Construction Cost:* I , ~0fZ_ Mufti-Family Building: (Yes / No )
Company: /11I Y cAY1SjVUchm MaMexvtunt Contact: JX A sftcl
Address: 5145 IM A A St. S%Ai* # 103 City: I ( h
Contractor
State: Zip: CJcJ3SoI Phone: a -151-0141- 11-,
15H
License M -BCA 10J 7cJ' Lead Certificate M N AT" 2U°II-011-4 -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:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
i NOTE. Plans and supporting documents that you submit are considered to be public information. Portions of
i the information maybe classified as non-public if you provide specific reasons that would permit the City to
conclude that the are trade
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.clopherstateonecall.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 Minneso late Building Code must be completed within 180
days of permit issuance,
x lot, 74 1 e%-L--ad x
Appricant's Printed Name Appli s Signat e
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