4401 Slater Rd -Permit and app
Use BLUE or BLACK Ink
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City of Eap , Permit#: I
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I Permit Fee: I
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I ,
Fax: (651) 675-5694 I Staff: ,
1
2013 RESIDENTI~~AL BUILDING PERMIT APPLICATION
Date: Cella /1 j Site Address: qL A C 5 ~Gtl C~ Unit
Name: Her S~r~twy\ Phone: t 12 ~ ( ~~7T 7
Resident/
Address / City / Zip: _ q7 oC S ~.+er ~GgAY~ f M 6 5~ Q.
Applicant is: Owner L Contractor
Type of Work Description of work: lav ITT r'~► Ce5 'r ` aoe r
Construction Cost: 6Q . Multi-Family Building: (Yes / No
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Company: TW I n $Vv1eU045 Contact: *3d to
Contractor Address: 0k k CA,f 4 t. Vet City: h b a
State:
Zip: _ S~ 3 6 3 Phone: 7t 3_2q6
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License Co q5 r1 Lead Certificate
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 Building Code must be completed within 180
days of permit issuance.
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Applic n 's Printed Name Applicant's Signature
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