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1733 Bluebill Dr Use BLUE or BLACK Ink For Office Use I I f City ! Permit Z~ 3 a I -7 6' t Permit Fee: 3830 Pilot Knob Road t I Eagan MN 55122 Date Received. O I Phone: (651) 675-5675 j !LI" i Fax: (651) 675-5.694 I Staff. ~y L 2013 RESIDENTIAL BUILDING PERMIT APPLICATION ~~JC~OiII ~J~iV<. Date: 10Site Address: 1~7 17a9 l Z31 1733 Unit r 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__ M; 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) P , LeJ A C,+ - ,''~%cz t '1 .vim 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. X >2~ !2-'~ X1~_ Applicant's Printed Name Applicant's Signature Page 1 of 3