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3606 Denmark Ave 11/29/2016 1 : 15PM FAX 9529858836 Bulldog @0001/0007 Use BLUE or BLACK Ink For Office Use / I 41,1111 City . 1.r710 of�� Petmit Permit Fee; `I 3890 Pilot Knob Road Eagan MN 55122 1 9 Date Received: t Phone:(651)675-5675 I Fax:(661)675.5694 Staff: I I J 2016 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 11/29/16 Site Address: 1272, 1276 Duckwood Dr. ,-vv �� '� � 6 Unit II: 4'''•e: Name: Crossroads Partnership Phone: 651-454-3352 1 ®ardent/;;;;.;;, 1500 McAndrews Rd W. Ste. 100, Burnsville MN 55337 :g.:O.wnef,;:,;:' ',; Address/City/Zip: Applicant is: Owner X Contractor •' ' '`'"' '"`•:', .:.•,: Remove & replaced asphalt shingles '` Description of work: p p :Type:'of'Wt 'rk.:•• p •• Construction Cost , ��r d a 0 Multi-Family Building:(Yes X /No ) ','A,'"•,:i.:.:',..:,01 Company: Bulldog Contractors, LLC Peter Retka Contact : ""• r` .;,',••. 21663 Cedar Ave City: Lakeville a•:" Address: ,ti,:Contractor:a'' ;.,.: state: MN Zip: 55044 Phone: 651-253-8211 Email. pretka©bulldogroofs.corn • BC639635 NAT-F162654-1 License#: Lead Certificate# 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•ti be public information Portions Of••" the information maybe classified:as•non-public if you provide specific•reasons that would permit the City to • i..: ' ' . . •conclude•that the are trade secrets.... . . . ' CALL BEFORE YOU DIG. Call Gopher State One Call at 1851)454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.000herstateonecalt.orq 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 x_ ,rf cr � I ... Applicants Printed Name Applicant's Signature Page 1 of 3