3786 Burgundy Dr
,i1~c~l'en~ Use BLUE or BLACK Ink
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I For Office Use I
f City l"' Permit
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bb I Permit Fee: ' I
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675
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Fax: (651) 675-5694 I Staff:
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2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: 378-11- e7 4- I -e4 /✓r° ilOnit
i Name: ~enE Phone:
Resident/
d' r'
Owner Address / City / Zip:
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Applicant is: Owner _)C Contractor
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Type of Work Description of work :T ,C e ~ /
Construction Cost: c Multi-Family Building: (Yes / No
Company: ~el31he:s yehe~ e Contact:
Contractor Address: - ~T9Q City: 1244
r State: Zip: Jf`7I3 Phone: alt ~ ?<31 ~ddr,
-7 rt
License #:Lead Certificate ~1,1161 f 1 vc.
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?
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_Yes _No If yes, date and address of master plan:
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Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
j the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
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.oopherstateonecall.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 Minnesota State Building Code must be completed within 180
days of permit issuance.
X_ < 3( L L.~- I V l V" X
Applicant's Printed Name Applicant' Signature
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