1267 Vildmark Dr- Building Permit
Use BLUE or BLACK Ink
r
For Office Use I
Permit J I
City of Eap ;
Permit Fee: V
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675
Fax: (651) 675-5694 I Staff:
I 1
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: a~7 %~o~rktnk Dr. Unit M
Name: Phone: V ~i " 02`l7 ' iLJZ
Resident/
Owner Address / City / Zip: at-. S .4
Applicant is: Owner X_ Contractor
Description of work: K e,tx,T" 14a,,-e- ! A ~ Ga r,.~
Type of Work
Construction Cost: d Multi-Family Building: (Yes / No
Company: S. Q~1D:alea~• ~,~5~• Contact: _16-Ac- III."*'d _1qL"
Contractor Address: )(Gc-l AA-15, 4eV city: f.1 tie. t er
State: /-k Al Zip: SS ~3~ Phone:
License is r~~ 2:1 b Lead Certificate /"~c 4 ' $y I go -
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.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 Buil mpleted within 180
days of permit issuance.
x O K _ &1 eayn x
Applicant's Printed Name A nt's ignature
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