1526 Greenwood Ct NRESIDENT i
OWNER
Name: i ∎ o f - y r - t -k-S r r a . A . : 4 - \ > » ' . y e a ,c >C. Phone: C) 453 I -1 a 3 3
J
/ '
Address / City / Zip: 61E 3 S CA 111 LA-) ( " 4 " - `pct r -�■-.:n t/
Applicant is: Owner A_ Contractor "1en Q {Z. w - \ �• , t'Yl ►'1 5 5 '3�f 1 1
TYPE OF WORK
Description of work: re r0() C
p
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Construction Cost : 1 2 09 ST O ) Multi- Family Building: (Yes l( / No
CONTRACTOR
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11 ✓t
Company: 'E C I&- IC.b0 "11 1/1 1 � &Pif de.1 l Contact: 1<0. i�
J St jl
Address: �I IOu t,XCt.\ 0 r I V c6. City: fSt , C! bt,l1 S PO I -k_
State: yYI L' Zip: 5 S' 1 L> Phone: C ) 6:-/-9 1 5 - - 7 c,Z:Z C.
License #: C `2 UCa \ 0 50 Lead Certificate 9/: AM T -- a 5 b3 (/ `•'
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 City 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 fhe City to
conclude that they are trade secrets.
Aug. 1. 2012 12:37PM Sela Accounting No.1661 P, 10
City ofEaall
3630 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
r
Use BLUE or BLACK Ink
-
For Office Use
Permit it:
Permit Fee: ems 2 • L�
Date Received:
Staff:
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
Date; V I 11 2 - Site Address: Oa, 152-q , 16Z1, ) 6Z8 6'eenwoeci C (1 Unit #:
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 locates of underground utilities. www.gopherstateonecall.orq
1 hereby acknowledge That this Information is complete and accurate; that the work will be In conformance w lh the ordinances and codes of the City of
Eagan; (hat I understand this Is not a permit, but only an application for a permit, and work Is not to start without a permlt; That the work will be in
accordance with (he approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit Issued in accordance with the Minnesota state Building Code must be completed within 160
days of permit Issuance.
x
)r 1 Vn G'e r 4).-N'e r-
Applicant's Printed Name
x
Applicant's Signature
96; -6 _ - 7? -(1 '
Page 1 of 3
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