1521 Woodview Ave W
From:ALLSTAR CONSTRUCTION 19529427464 05/07/2014 10:08 #166 P.008/037
151, I51~~ IS I~ , 121 Woodu~
Use BLUE or BLACK Ink
I For Office Use I
j Permit#:
City of DEB I Permit Fee:
3830 Pilot Knob Road I
Eagan MN 55122 Date Received: j
Phone: (651) 675-5675 I Q~p I
Fax: (651) 675-5694 I Staff: ( h 1
I 1
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 5'1-119 Site Address: I5~;; i~ Cl11C,11 J511 WUWV1ew Wts+ (Guvme ~l T$ Otm~~
Name: SUTY_ fi b T > CIO, ~IOVSm ~mDOIYI U Phone: S9
r Resident/ t
Owner Address/ City/ Zip:163 b CI VV, PArkWOWI g-1101 PI?A(dt o M N
-_._.^F ( Applicant is:_ Owner _)L Contractor
Type of Work Description of work: Tea it off Re - RD of
a Construction Cost:. 1 2I I ZOO , 00 Multi Family Building: (Yes X / No )
k Company: AIlstay UnsInA Dn1 i7(r101_ 01_ GY) U7i, LUG Contact: tdYlt MC4yololn
E
City: Map(t. Plol(n
Contractor Address: StyS 1Y101VIStYiOll Sf _ 1110:1)
State: _KNZip: 953r-3'1 Phone: - Email M k Mist t . W I
` License P,431 G-5 Lead Certificate N AI- 2 A (0`1- O I
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) m
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 N you provide specific reasons that would permit the City to
conclude that they are trade secrets.4
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. www gooherstateonecall,oro
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.
Exteriorwork authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
k Mlle mtbe►-mpt x
Applicant's Printed Name Applicant's Signature
Page 1 of 3