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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'