3490 Trails End Rd06/08/2011 14:37 6128616267
Date:
Tenant:
City of Eagan
3830 Not Knob Road
Eagan MN 55122
Phone: (661) 675 -5675
Fax: (851) 675 -5694
BEI EXTERIOR MAINT
PAGE 03
I /0082 5
Use BLUE or BLACK Ink
Neggi*,1j if
Permit #: /1-11
Permit Fee: / s V o
Date Received:
Stet;
2010 RESIDENTIAL BUILDING PERMIT APPLICATION OA-
5/04i ( Site Address: 3y 7~.e,4ILS iV1. WV
Licensed Plumber:
RESIDENT I OWNER
TYPE OF WORK
CONTRACTOR
x
Printed Name
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a pennit fora similar plan based on a master plan?
Yes No If yes, date and address of master plan:
Sewer & Water Contractor,' Ph one:
Suite #
Name: 5,e? A .44 114 EG /j4 xir Phone; 76 3- .x"93 ° 110
Address 1 City / Zip: 1S i  ¢z ,v6 1V Got -i. t/ /,g ' 4 ' V 77 ,
Applicant is: Owner Contractor
Description of work: [-4e 1"6 Am p .r ��i v rr
Construction Cost , -R4GO Multi- Family Building: (Yes _ 1 No- )
Name: 1"7e/ r Zl ore /d-14 /,'tWT. CU2. ° License # 202 V/13/
Address: 90S GC1 C,o m '7 z r City: 4440 Pain"
State: gal Zip: - 1 0 Phone: ‘41. $'rra /- l 1 7 1 ,
Contact: PA-UL.. Email: 477 i- be/ 64/7 -
Phone:
Mechanical Contractor. Phone;
NOTE Plans and
supporting that u suftmil are. corisfdered,:tip °tieptrbtigintirfimatiorl, : Porffgns of
the lnformatlon MO be clesslfied as nr n pwfilic if 'you prtiivklaapecltic;reasons :that WWouffo , Permit thR City fir
conclude that• #hey are trochisecrets`.:
C I.L. B ORE Y IG. 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 o underground utilities. yuww.000borstateonecallon4
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
Sagan: 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 of plena.
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