3496 Greenwood Ct SRESIDENT I
OWNER
Name:" 1 ,. -el - .'N u'lige CA.% 0 C. Phone: ( I S.:;t -4'31 ^ P- 3 3
I , ( 'r t; r
-'_ Ca c?
Address / City / Zip: 0 CA, +v Lie! Par 1 .■_Xl y
£ -,:l _tn 9no. ve, , m t'N 6 5 3 (4 t-/
Applicant is: Owner X Contractor
TYPE OF WORK
Description of work: re 'roc) C --
Construction Cost; i dZ (A 5 UC) Multi- Family Building: (Yes X / No _)
-
CONTRACTOR
Company: S e tcL 2 O -1 Yl c) 4. R trl cXt eJ 1 ✓1 Contact: 1Nq r^ ‘ 1..
Address: 9100 f,xCt.k SI o t' e \ V cL City: 5t r LUt-v 1 S Pa 1
•
State: yYlY \ Zip: tJ 5 1(v Phone: q 6:1-9 1 5 -- --- 101,-, L
License # : C- 1 2 . O O \ D 5 O Lead Certificate #: NA — p. 5 0 3 q J
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 Clty of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor:
Sewer & Water Contractor:
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 specific reasons that would permit the City to
conclude that the are trade secrets.
Aug, 1. 2012 12:36PM Sela Accounting
Date:
C!ty of Eaali
3830 Pilot Knob Road
Eagan MN 55122
Phone; (651) 675 -5675
Fax: (651) 675 -5694
Applicant's Printed Name
No 1661
Use BLUE or BLACK Ink
For Office Use
Applicant's Signature
Dale Received:
Permit #: /,' T
Permit Fee:
Staff:
2012 RESIDENTIAL BUILDING PERNMIT APPLICATION
X1 /1 z site Address: 349L1 3 Y (o 3'49 3560 6reen1,0occL C +. S unit #:
CALL BEFORE YOU CHG. Call Gopher State One Cal( 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.gooherstatennecall-orq
1 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 1 understand this is not a permit, but only en 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 approves of plans.
Exterior work authorized by a building permit issued In accordance with the Minnesota State Building Code in ust be completed within 180
days of permit Issuance.
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