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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 e 0 Phone: {Name: Resident/ i Owner Address / City t Zip: Applicant is: Owner Contractor 3 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 1 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 Page 1 of 3