3432 Highlander DrRESIDENT 1
OWNER
Name: ... /: e, rz 014 . / .D & L I II ./ ^hone:`/ — I901 —' c i
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Address / City / Zip: 1 �` / . +� 4i_. .
Applicant is: Owner A. Contractor
TYPE OF WORK
Description of work: , iz s Imo, / / L t 1 / +
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Construction Cast: f t f � ' Multi- Family Building: (Yes / No )
CONTRACTOR
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Company: j hi 6 Contact: f
Address; 4LO0 f./ 10 - City N. LO J
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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
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tpa
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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:
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Owner v ai • Address: }
dress z
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Plumber � - `�
. of Eog onn ct Cha rge' .
= 1 agree to c with ; e `cit'Y , c t a egos t. ,
Ord inances.
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Z ' horges.
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