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3432 Highlander DrRESIDENT 1 OWNER Name: ... /: e, rz 014 . / .D & L I II ./ ^hone:`/ — I901 —' c i I I Address / City / Zip: 1 �` / . +� 4i_. . Applicant is: Owner A. Contractor TYPE OF WORK Description of work: , iz s Imo, / / L t 1 / + 1 DI( .. ...� ,I i Construction Cast: f t f � ' Multi- Family Building: (Yes / No ) CONTRACTOR _ Company: j hi 6 Contact: f Address; 4LO0 f./ 10 - City N. LO J . , / State: ZIP: �' phone: life t / 4eR_3 - 11g7 License #: 0 Lead Certificate # AJ n'/4 : r - 1 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: Plans 'and supporting. documents: that you submit are considered to be public information. 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. Jun. 8. 2011 2:45PM SELA ROOFING City of EaQaIl Date: 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 676-5694 Applicant's Printed Name Applicant's Sign i re No. 6530 P. 14 Use BLUE or BLACK Ink Permit Fee: T'33L1 a5 Date Received; Staff: _ 2011 RESIDENTIAL BUILDING PERMIT APPLICATION Site Address:C 4 , R • (5S lab ` .: 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.00phera_tateonicall.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 p# plans. Page 1 of 3 i -,.' WATER SERVIC PERMIT �i L5 s j%,n ' a F - • .-. s 7s '. t 1 ` ob R �I4RM!T N O r a , t - '' E ' 1 55122 ` "DAT ' ', ''.1_4:....f— y " , � � n n: t ,;N,'-_-. o of -.Uni ,.m a Add 15ess ay ; 7 • - s zee k "i 3 ` - tpa � ! 7�dre�S a: , 1� �� �' l umbe fi � ?tea -44 , t , sa *ct � 7, et; er No y Conne ction Charge : Size: . =r , �. Accoun Depo ° '` ' rx # . Permit Fee gg re e to comp w i t h t he City of Eagan Surcharg � � � • Ordin Misc < Charge - ? , ra Total: BY . '`D " Da ,o - I nsp t ' Insp SE WER �SE PIT ,` -. E . .. ' a_,. Irk 4 RICAIT N Kn ob Ro t 37 � r D TE l ' : # S '"- = g an ; N 5 51 22 0 , f U nits __ -' Z oning lf•"°� � . � ' � - _ Owner v ai • Address: } dress z • �� te Ad . • "'. • INI ilia 11 ' � ' Plumber � - `� . of Eog onn ct Cha rge' . = 1 agree to c with ; e `cit'Y , c t a egos t. , Ord inances. • e� ee Z ' horges. BY .�. --•= Tot � � , D ate of I n sp. t ti lot �d+ nsP + t __