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3498 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. Page 1 of 3