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4126 Wenzel Ave - Building Permit app Use BLUE or BLACK Ink r For Office Use U ~y I Permit I I y g City of Ea Edii J , ~S Permit Fee: 3830 Pilot Knob Road Eagan MN 55122 Date Received: (01013 Phone: (651) 675-5675 I I Fax: (651) 675-5694 1 Staff: I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 13 Site Address: 1/09 all /v Unit Name: Ze5?~ Phone: Resident/ Owner Address / City / Zip: gUef N ~ Applicant is: 1/ Owner Contractor Type of Work Description of work: 242aiaa~ e, I Construction Cost: OOD Multi-Family Building: (Yes / No 6~Company: - 'C~~ le, Contact: bl Contractor Address: 3Z_`2__ l S / a Vic) ~(J~ city: State:" Zip: 5 Phone: License 7 Lead Certificate 012 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: NOTE. Plans and supporting documents that you submit are considered to be public information. Portions of 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.gopherstateonecall.om 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. _ )0C xd OX Applicant's Printed Name Appl cant's Signature Page 1 of 3