3606 Crossroad Ct 11/29/2016 1 :01PM FAX 9529858836 Bulldog 110001/0007 rr�
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City of Eaaali Permit#: /
Permit Fee: .2-7f3. cd
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone:(651)675-5676
Fax:(661)675-5694 Staff:
2016 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: L.
11/29/16 S Address: 1252, 1256 DuCkwood Dr. -�� `�/ ���� `�� ( .
Unit#:
`` :' : ; ; Name: Crossroads Partnership Phone: 651-454-3352
;Resident/ ,;+.:, 1500 McAndrews Rd W. Ste. 100, Burnsville, MN 55337
:':,o Tyne �;; ',:' Address/City/Zip:
:;i: `"' Applicant Is: Owner X Contractor
"' Description ofwork. Remove & replaced asphalt shingles
X13: , Construction Cost
,, �,, ���0 Multi-Family Building:(Yes X /No_j
'.'-` , Company: Bulldog Contractors, LLC Peter Retka
::' Contact:
Address: 21663 Cedar Ave Lakeville
>.Contr'actor:?.c;: City:
{'' State: MN Zip. 55044 Phone: 651-253-8211 pretka bulldo roofs.corn�
<;: Email: @ 9
. ;;a,..;,�;;.;.`,,. License#: 6C639635
Lead Certificate#: NAT-F162654-1
If the project is exempt from lead certification, please explain why:
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:
Fire Suppression Contractor. Phone:
NOTE;Plans and supporting documents that you sutimlt.are considered to b'e.public'information: Portions"of
the information may be.classified as-non-public if you provide specific reasons;that wou/.d permit the City,,to
.. ` .. . . conclude.that they are bideSecrets. .. `1
CALL BEFORE YOU DIG. Call Gopher State One Call at(651)4544002 for protection against underground utility damage. Call 4a hours
before you Intend to dig to receive locates of underground utilities. www.000herstateonecalLorg
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 permit,and work is not to start without a permit; that the workk 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 Peter Retka *7%1 i;
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x
Applicant's Printed Name Applicant's Signature
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