1733 Bluebill Dr
Use BLUE or BLACK Ink
For Office Use I
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City ! Permit Z~ 3 a I
-7 6'
t Permit Fee:
3830 Pilot Knob Road t I
Eagan MN 55122 Date Received. O
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Phone: (651) 675-5675 j !LI" i
Fax: (651) 675-5.694 I Staff.
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2013 RESIDENTIAL BUILDING PERMIT APPLICATION
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Date: 10Site Address: 1~7 17a9 l Z31 1733 Unit
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Name: Phone;
Resident/
Owner Address f City t Zip: _
Applicant is. Owner Contractor
Type of Work Description of work: )eL C?
i Construction cost: GLI ~ 0 Muni-Fatuity Building: (Yes t No
s Company: ~~~~'tttn¢le( t.S nc~~Ia~iio~S Contact ar✓Q__
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Contractor Address: -City: ' e\,\R"6^k-°''
M tj Zip: Phone: 6, - t~ <.1 ' e2 0ro
State;
License #:_)L t 5 Lead Certificate f1) P-F Utp - -t
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
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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 amaster 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 maybe 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.
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 pernat, 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 Applicant's Signature
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