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1757 Bluebill Dr ,r 4 _ x`15 ~ , S~ i ~ -is~-, 115'1 '~31 u~"► Ca Use BLUE or BLACK Ink For Office Use 1 Permit { 1 U ~J { ~7 i Win C, of Ea ► I Permit Fee: = '-I a ~ 3830 Pilot Knob Road i 2 ► ► Date Received: 2~ I J ' Eagan MN 55122 Phone: (651) 675-5675 a,n(Z i Fax: (651) 675-5694 i Staff. -LLB- 0-I0 t------------------ 2013 RESIDENTIAL BUILDING PERMIT APPLICATION 1(?°o"I-f3 Site Address: 1751 1-753 i7S5 1757 ltd-Ilo C;cc.ld Unit#: Date: Phone: t Name: Resident/ i 9 Owner 1 Address / City / Zip: I Applicant is: Owner Contractor i Description of work: Type of Work g Construction Cost: i 50 0 Multi-Family Building: (Yes I No ) Company: Dc-\-, oeA!-e- Acr- F + ~Ic~rian Contacct- 4O Dckr ~ t,~ C3 L~ 1 ~r~ : Cax Z)r d City: i r nn4 rmlr.~ Contractor Address: State: 01 A) Zip: Phone: 5 - 29ao I ,t License #:)~--9Lv 5 `t Lead Certificate A t~3 T- - If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) Y 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 the are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Cali at (651) 454-0002 for protection 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 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 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 ~K Uc cActr X Applicant's Printed Name Applicant's Signature Page 1 of 3