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3607 Crossroad Ct 11/29/2016 1 : 12PM FAX 9529858836 Bulldog Z0001/0007 Use BLUE or BLACK Ink For Office Use J —7 I Cityof Eataft Permit#: /10 3830 Pilot Knob Road Permit Fee: Eagan MN 55122 Date Received: • Phone:(651)675-5675 Fax:(651)675-5694 Staff: 2016 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 11/29/16 Site Address: 1264, 1268 Duckwood Dr. 60C.' -z6°7 C� os� CS • Unit#: C-71; • Crossroads Partnership Phone. 651454-3352 :':•ResidohV•.,;.;�:,•: address,city/zip: 1500 McAndrews Rd W. Ste. 100, Burnsville, MN :55337 Applicant is: Owner X Contractor ', Description of work: Remove & replaced asphalt shingles :;Type•of Work-; _' ;'.•` Construction Cost 0 Multi-Family Building:(Yes X /No . ) Company: Bulldog Contractors, LLC Contact: Peter Retka 21663 Cedar Ave C,oritracto r'' Address: City, Lakeville ..'; State: MN zp: 55044 Phone: 651-253-8211 Email: pretka@bulldogroofs.com Lead Certificate ii NAT-F162654-1 License#: BC639635 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'documentsi that•you sub'niltWre.considered to be public information Portionsof the Informationmay be classified as•non public if yojr provide specific reasons•that would permit*City;to. conclude that they are trade secrets: ' • ' CALL BEFORE YOU DIG. Call Gopher State One Call at(651)4544002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locales of underground utilities. www.noaherstsjteonecall.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. 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 Applicant's Printed Name Applicant's Signature Page 1 of 3