1516 Woodview Ave W
From:ALLSTAR CONSTRUCTION 19529427464 05/07/2014 10:10 #166 P.014/037
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Use BLUE or BLACK Ink
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I For Office Use I
j Clt~ Permit I `Tlp j
of Eallan
~ Permit Fee:
3830 Pilot Knob Road
Eagan MN 55122 Date Received: ry IV
Phone: (651) 675-5675 1 I
Fax: (651) 675-5694 1 staff: _ I
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2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: _r014,I51U,~rll 152,0 woacrv►twwel+fp3AY010t oW ~amtJ
~..{._._..~..r----..~ Name:
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NYr u Ht,,aVri~ h to ftmban a Phone:
Resident! ~-%J
Owner Address / City / Zip: (H~ CI W~ W, PgrkVVX4 I CWY1 NC rit, M N 5S~`-r
Applicant is: Owner Contractor
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Type of Work Description ofwork: ~:R!_..._ off I iCe. - P-0 Vf
I Construction Cost.. 12 t 1 t 2,01) - Olt) Multi Family Building (Yes X I No
kny:Allsby ompaUlnst mct on Mahaaeamrxrt, LLL Contact: -bayle MCIhCYaan
Contractor ¢ Address: 5195 ~Y oyistrial Sf _ #102 City: ple. Plain
State: _MN Zip: 5 Phone: Email: {;IQYtQ ~aIIS~DIY•bL
l ~N License tD3I S15 - Lead Certificate* N A T- 21A(P 1- 0
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
I 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?
I
_Yes _No If yes, date and address of master plan: I
F
Licensed Plumber: Phone:
(r Mechanical Contractor: Phone:
f
Sewer & Water Contractor:_ Phone:
NOTE., Plans and supporting documents that you submit are considered to be pub/ic 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. www.gopherstateonecall.org
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.
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Applicant's Printed Name Applicant's Signature
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