3415 Highlander DrRESIDENT 1
OWNER
Name: 166 Q W ,/W Y 1 ne %rayg -57 7
Address 1 City t Zip: (340/ (546 M /561( tJl JIM 31 . r 1
Applicant is: — Owner Contractor LLJJ��
TYPE OF WORK
Description of work4 1!A ' ! / "�i.1101. • L iZ ._,� I r.,. •
IF gir
Construction Cost O4 . 0 /IL Multi-Family Building: (Yes / No )
CONTRACTOR
Company: Rcorl 1V r Contact: J 44 Irk , y
Address: lot 1 W City: 5 . Jj 1'"L (
/
State; rtC.9 55 x'`! Zip; Phone: /el (- `7 69,96r/ !.
License #: OD ` Lead Certificate f#: // t ^ Vc 4 —
If the project is exempt
from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
Yes No If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor.
Sewer & Water Contractor:
Phone:
Phone;
Phone:
NOTE: Prins and supporting.documents that you.submit are considered-to . be public inforrnation. 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.
8. 2011 2 :42PM SELA ROOFING
*City oi6api
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
x ►,44/61 Uk-AA110
Applicant's Printed Name
of X936
N o.6530 P. 2
Use BLUE or BLACK Ink
Permit # 9
• s Permit Fee: g a
Date Received:
Staff:
/ j 2011 RESIDENTIAL BUILDING PERMIT APPLICATIO �
Y L Site Address: _ ij �( f ( 3 01 i �� { }! ni #'
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.aopherstateonecall.orq
I hereby acknowledge that this information is complete and accurate; that the work will be in oonformance
Eagan; that I understand this is not a permit, but only an application for a permit, and work is riot tO Start
accordance with the approved plan in the case of work which requires a review and approv-• plans.
err. .di A .-1 _
plicanr's Signature
the ordinances and codes of the City of
flout a per 't that the work will be in
7
Page 1 of 3
EA GAN AVA a 1 RV10E PERMIT
" If
4 Road PERMI"1` O : t . ;
N S: 5i2f DATE: f r ` ' t:
?n1ng; No. of Units:
Owner. B ' � . a * 1 � ,„
Adds:
Site Address, t. "_ I f a t, ^ : r 1 . r, . 1,1 r 1 RI. N . t 7 1
Plumber: ' "� r c* . P 1 tt: : ,, ' •
Meter No.:, Connection Charge: 1 ' ° • t i ' ` P
Size. Account Deposit:
Reader No.: Permit Fee: �) . ? I 4
1 ogee to comply with the Village of Eagan Surcharge: ' 5 n l'`
d
Ordinances. Misc. Charges 0.00 cl' e x
Total:
By / f • to Paid:
Date . ot nsp.: A ll as•/ - Insp.:
mug OF EAGAN SEWER SERVICE PERMIT
379 ^Pilot Knob Road
� PERMIT NO.:
ibgan, MN 55122 DATE:
Zoning: No. of Units: P " •
Owner: I r •o <, 0
Address:
Site Address: 1 41'; MT i c , 1 a n r '� t°,, ' ? 1 r.. ;.
r
Plumber: x o j r c t xs 1 um} i. r k; CC,
? 0 0 . 0
agree to comply with the Village of EagaW t ni;ecitajon',6hWP • °r=
Ordinances. Account Deposit:
Permit Fee: 1. 3 * t! 3'1
Surcharge:
By: Misc. Charges:
Date of Insp.: Total:
Insp.: Date Paid: