1745 Bluebill Dr
Use BLUE or BLACK Ink
For t!#fic~Use 1 Permit
I
City of ~I I
Permit. Fee: oZ o7 I
3830 Pilot Knob Road I
1
Eagan MN 55122 Date Received: Z 1
I -10-~--~ I
Phone: (651) 675-5675 1 1
Fax: (651) 675-5694 I Staff
014j L-------------------
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 0 -;n-13 Site Address: 1-7 441 1 '7q3 1-7 q5, 17,4 -7 Unit
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Phone:
{Name:
Resident/ i
Owner Address / City t Zip:
Applicant is: Owner Contractor
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Type of WOrk Description of work: )e=g_ CaQ
I I Construction Cost: Multi-Family Building: (Yes l No )
Company: ~C ~'lofr~ ¢ ,e ~1" t V eion Contact: J 01 t✓ctr
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Contractor i Address' ~~e f~ tr q ~t City:+ nne~k a
f State: mAJ Zip: Phone:
License ILL cJ 5 Lead Certificate A -F_
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.
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 approvalof plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of pennit issuance.
X S- a,,, I --5Q c* 4t-r x ii,>--
Applicant's Printed Name Applicant's Si nature
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