1740 Bluebill Dr
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~ Use BLUE or BLACK Ink
For Office Use I
1
Permit r 3~ ~I
411100 I
City of Ea a~ I Permit Fee: -1aa. 7S j
3830 Pilot Knob Road I 1
Eagan MN 55122 I Date Received: 2-~ !
Phone: (651) 675-5675 Q.n_
Fax: (651) 675-5694 1 Staff -67~-GZ-
it i3 L
2013 RESIDENTIAL BUILDINGPERMIT APPLICATION,
Date: Site Address: 173$ I ,7q(7 17Na 1-7444 JQbit~ ut Unit
Name: Phone;
Resident!
Owner Address f City f Zip[
l
y Applicant is: Owner Contractor
t i
I Description of work: Ck {
Type of Work I
Construction Cost t Muhl-Family Building: (Yes f No )
Company:C ~t+~{r~ 42 d.QJ° '~nytc~ra°y Contact
d
;Address: <rc.u. ~r . City:
Contractor {
State: ()I A) Zip: Phone:
License f6c <)q(y b q 5 Lead Certificate f) PT - o~UC1a'? °
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 plait 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
I the Information may be classified as non-public if you provide specific reasons that would permit the City to
conclude thaf they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Cali at (651) 454-0002 for urctection against underground utility damage. Cali 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 vritl he 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 penn t, 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 mast be completed within 180
days of permit issuance.
x o - c_k t x
Applicant's Printed Name Applicant's Signature
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