3455 Highlander DrRESIDENT 1
OWNER
Name: . . _/_., d I , 1 Z) L i L/ Win e : /5r — --� 551
�. /_, / /, t ( .
Address / City / Zip: � � (GrfJ � A
Applicant is: Owner Contractor
TY OF WORK
Description of work: �_ #t4 Gt / .4 j • : �
V
Construction Cost: « r V (1 Multi- Family Building: (Yes y, No )
CONTRACTOR
Company: c XJL/4 � 6 6 Contact "LK- A Uf J V Il �.yl
��
Address: 410 i City: S I i I2
,2.,..c
State: Zip: C "d`Y w Phone: L�`� 1' &a, / 1 rd)
,� j �j
License #: IOSO Lead Certificate #: l \1 [1 I - X) ') ' O' - 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
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
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:
Phone:
Phone:
Phone:
NOTE: Plan an d supporting ocuraents that you.submit we considered to be public information: Portions of
the.inforrnation may be.classified as non-public ifyou provide specific reasons that would permit the.City,to
conclude that they are trade secrets.
Jun. 8. 2011 2:48PM SELA ROOFING
4 CityofEaali
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
Date:
M V V1 ,
Applicant's Printed Name
2011 RESIDENTIAL BUILDING DI I M1T APPLICATION
x
Applicant's Signature
No.6530 P. 29
Use BLUE or BLACK Ink
Permit #: C /
Permit Fee: lY 33 '/
5 . Date Received:
Staff:
J
G d ;: ;:: & &, 3-16 / /um5 4 gi6
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 [abates of underground utilities, www.g.gpherstateonecali.ora
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 approv plans.
Page 1 of 3
WATER SERVICE PERMIT
It �„ EAGi1N � ',
' PERMI I
nob Road + "` " �"I,l
N 55122 DATE:
-,-.. .:fi i No. of Units:
Zoning:
Owner; Co. staiie►n - void Nittdallio - ..
Address: pig 5 3Ii4
Site Address: 3455 Ili' 1 r Dr . L2
Co snso l idatcd Plumb � • +l
plumber 1.60.On pd
Meter No.: Conn ection Charge:.:
, Account D
Size: .113.44) .p ...
Permit Fee:
Reader No.: + 50 pd
1 agree to comply;, with the Village of -Eagan Surcharge:
Ordinances. Misc. Charges:
i '
C Total:
` I " ' Date Paid:
_Date of Insp.: IF Insp.:
Amp OF EAGAN v_ ' SEWER SERVICE,PERMIT
4795 Ptlot Knob Road PERMIT NO.:
tayoa, MN 55122
DATE: 7/27/7f'
g Na. of Units:
Zoning: Gus:. tta f son C O1 5 ' e -. tl __ _ __ .
Owner: _
Address: ~ Y 1121111.1111 a ,
34 S ( II �A . S * _
Site Address: -'
Plumber: Gv nsd 1 ` dat ' _ .'•
-.---
agree to comply wit ' Ip of Eagan : C^n n ecti o n arge:
Ordinances. Account Deposit:
Permit Fee: 10.011 pd
Surcharge: • 50 pd
)._ �? C � ` Miser Charges:
By .
Da te of Insp.: Total:
Insp.• Date Paid'