4126 Wenzel Ave - Building Permit app
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Permit I I y g
City of Ea
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Permit Fee:
3830 Pilot Knob Road
Eagan MN 55122 Date Received: (01013
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 1 Staff:
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2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 13 Site Address: 1/09 all /v Unit
Name: Ze5?~ Phone:
Resident/
Owner Address / City / Zip: gUef N
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Applicant is: 1/ Owner Contractor
Type of Work Description of work: 242aiaa~
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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.
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Applicant's Printed Name Appl cant's Signature
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