Loading...
3442 Highlander DrRESIDENT t OWNER Name: f .11 _: sl. 9 At/AY?) - Gum l i iLe ne:15 - l aa- 55 0 c o r Address / City / Zip: r 0 Fri 1 / / / O * 1 II Applicant is: Owner _, Contractor TYPE OF WORK Description of work: " ' i /.yi Il t 1 _. d Pill, I Construction Cost: 40 Multi - Family Building: (Yes i I No ) CONTRACTOR _ Company: ccah 146 r1 Contac / 1 V d,k U. il. Address :4 6 De g D City: t,t,s State: Zip: (664 1( Phone: Lp fa P3 1 - -G /C G a , License #: a)61060 Lead Certificate #: NM 6 " A5064" 064" If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) In the lest 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 nonpublic if you provide specific reasons that would permit the City.to conclude that they are trade secrets. _^ Jun. 8. 2011 2:46PM SELA ROOFING 4 111 ' City of Eagli 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 Date: 2011 RESIDENTIAL BUILDING PERMIT APPLICATION Site Address: b tit C/4 • L� 34 Anit #: x (9 V 1 l Applicant's Printed Name Applicant's Signature No. 6530 P. 20 Use BLUE or BLACK Ink Wegr.W.Pr Permit #: 9 Permit Fee: 1,31/. as Date Received: Staff: GALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454 - 0002 fot protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gpphersteteonecall.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 : rt without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approy.of plans. Page 1 of 3 �_ `� i " � fR .SER E PE RMIT { �' ' oad t PERMIT�N s ` ° ,� _ ;a � #(. d ress :� f'^ ,_ > ^ � , - �' � v o ` C Charge., y } Acco aD ep o sit - ?jam e Flo � d � � �_ g Pe rinit � Fee -. .' , 3 * '. � JY with� C.ty o : '''''''' it ' ;''' a, Sur charge - ' d ' . a; `,, • d nanse fvlisc Cha r g es I p Total y Dote Pa A l 1 D df �hgp F r h asp. MEA , L R E V ICE PERMIT ` i r ; r, e. � E R ; IT S '` i IA 3 S al o e Knob Ro °' Eg Pil o t 551 2 2 AT , t - > Owner �` >. *, "� f a Frz k R``� ' a ''gam f ,�` �„ "-" , g ` f r - .., .n , > ss xr "' „ < ddre w 1 ` Addre s ' +€ ' a o "� i _ , Plum , - . -j i - „ a gr ee o co i M itzi th C it y o E agan '" C Charge +� ,,,,',74:- � " ` _ p rdi a�faes. a cctu� De {iosit { E �: a 1 yx ^s, � . ' -. F :'; . - ' 3 a ,, S �irch orge Mi C ha r ge s' ` Dat of ` .lnsp , _ `ot nip - D Pad ff