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3615 Crossroad Ct 11/29/2016 1 :09PM FAX 9529858836 Bulldog l60001/0004 Use BLUE orrBLACK Ink For Office Use City of Eaali ::: ` 3830 Pilot Knob Road Eagan MN 55122 Date Received: Phone:(651)675-5675 Fax:(651)676.5684 Staff: 2016 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 11/29/16 _Site Address: 3609, 3611, 3613, 3615 Crossroads Ct. Unit#: Crossroads Partnership Phone. 651-454-3352 Rider ti ''` Address/City/Zip: 1500 McAndrews Rd W. Ste. 100, Burnsville, MN 55337 ;:OYi(tter•;'`•'";;.�,•;::• Applicant is: Owner Contractor Remove & replaced asphalt shingles •Wo� "' Description of work: P P 9 �•TYPe�of:� �'? Construction Cost: $15,000.00 Multi-Family Building:(Yes X /No M`4 Company: Bulldog Contractors, LLC Contact Peter Retka s• 21663 Cedar Ave Lakeville Address: City: State: MN Zip: 55044 Phone 651-253-8211 Email: pretka©bulidogroofs.com BC639635 NAT-F162654-1 License#: Lead Certificate it: l 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 submit;are;considered to be public'inforfmation: Portions of • the information•may beclassified as non public if you provide specific reasons that would permit the City to ' conclude that the are trade'secrets. :I 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.00pherstaieonecaliorq I hereby acknowledge that this Information is complete and accurate;Ihet the work will be in conformance with the ordinances and codec;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 Peter Retka L�� ' • Applicant's Printed Name Applicant's Signature Page 1 of 3