3452 Highlander Dr•
RESIDENT 1
OWNER
T f —
Name; _Li 1 1 _I .) / it r ! t 14 .1i iL «..
P
0' $40 __ all �
Address / City I Zip: �' .
Applicant is: Owner Contractor
TYPE OF WORK
Description of work: 1- # A i 2 — L_I S A + r.� _"
r lV (V
Construction Cost: fu OD Multi- Family Building: (Yes _ 1 No )
CONTRACTOR
Company: & 01i Al Contact LL/l — & — •1 6 1
Address:40o0 �-�LOe City; . L�1(. c
State: l YLA- Zip: (554t Phone: 6 & ., —1q R
l •'' '
License #: I 0 Lead Certificate #: IV 4r c JQc
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 specificTeasons that , would permit the City to
. conclude that they are trade secrets. - -
Jun. 8. 2011 2:47PM SELA ROOFING
%T City of Eap
Pate:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675 -5694
C9€'
Applicant's Printed Name
C
pplicants Signature
No. 6530 P. 26
Use BLUE or BLACK Ink
Fpr_( £C o
Permit #:
Permit Fee;
Date Received:
Staff.
9q7aN
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
Site Address:c g • �c APPLICATION/1,,
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.gopherstateonecall.orq
I hereby acknowledge that this information is complete and accurate: that the work will be in conformance with the ordinances end 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 errnit; that the work Will be in
accordance with the approved plan in the case of work which requires a review and approv of plans
Page 1 of 3
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