1734 Bluebill Dr
Use BLUE or BLACK Ink
For € ffic a Use 1
~ Permit I
City of Ea
qI4 ~S '
{ Permit Fee: I
3830 Pilot Knob Road I
I Date Received: 2
Eagan MN 55122 l I
Phone: (651) 675-5675 Staff:~ I
Fax: (651) 675-5694 I 1
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42 a
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
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pate: lC3 'a2°i -1 3 Site Address: 17a_ ~I~ 1701( 17 a 7 304 1 3a1, 17 3'~ - unit ~M
Name: Phone:
Resident/
? Owner Address (City /Zip:
I I
I Applicant is: Owner Contractor
F ~ of Work ;Description of work: ~ cGrca~
V,& Type ;
t Construction Cost -75l,' ad Multi-Famiiy Building: (Yes /'ttiio )
Company: ~~1~~1®rn+e\~Qrva-~~ Contact Or✓Q~~ _
i Address: (9o '1 'v:rc + a nn~ ~rkem•
Contractor q ~t
State: Zip: ~2<23`4~ Phone: l Ja~° `~G,' C O
License 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. Por#!an$ of i
the Information maybe classified as non-public if you provide specific reasons that would permit the City to
w_conclude that the we trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 tnr h,ol(. clion against underground utility damage. Catl4s hours
before you intend to dig to receive locates of underground utilities.
I hereby acknowledge that this information is complete and accurate; that the work will be to conformance withthe ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, wid 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.
Applicant's Printed Name Applicant's Signature
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