3786 Red Robin Lane
(o 0 3~ 2 3~ 8 (o ~ 'Rdla1 n
Use BLUE or BLACK Ink
For Office Use I
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City of Eap 1 Permit
1 Permit Fee:
3830 Pilot Knob Road I ~a I
Eagan MN 55122 t Date Received:.
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Phone: (651) 675-5675 t t
Fax: (651) 675-5694 1 Safi' -a
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2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: iQ "-95-13 Site Address: ~J7"7a? 3-2Wo0 377$ 3 28o, 378a, 37$'u -Unit
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Name: Phone:
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Resident/
Owner Address / City / Zip:
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Applicant is: Owner Contractor
Type of Work Description of work: cc, is • n4y
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Construction Cost: 5 1 od Multi-Family Building: (Yes t No )
€ ! Company: Contact: 1 "'0' C>R
i Address: City: 3, Inc-,)C
Contractor
State. f f Zip: ~5 3 `>S j Phone: 1116 ~1 - ' f Gy " 09ac)
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License 06L`¢ c1 Lead Certificate #
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
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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:
MOTE: Plans and supporting documents that you submit are considered to be public information Portions of
t 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 Call at (651) 454-0002 for protechon against underground utility damage. Gall 48 hours
before you intend to dig to receive locates of underground utilities
I hereby acknowledge that this information is complete and accwate. the work w.ll be n 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 1 ~c _ `•c c r- x 1 J?
Applicant's Printed Name Applicant's Signature
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