1536 Greenwood Ct NREsIDEN,T/
OWNER
Name: 5■.Wv 4ttc\ -'-5 i..)....:)1 u'M (. ` () G Phone: ' i & -S 3 I - 1 D- 3 3
y
tY1.kt_ Ca: - c t w
Address /City /Zip: 66 .1 t.132" CA'r Wel* 1 ctr-- L-..XL V
F,,Arl Qrt :4\.v.__ t mn 5 r :3L'V
Applicant is; Owner Contractor
TYPE 0P WORK
Description of work: re 'COO T " _
Construction Cost: 1 ?' (Y1 S 00 Multi- Family Building: (Yes / No _)
Company: S C- CL 2bU -c r13 d. 1` iii txi Contact: 1 '‘ 11
1
Address: L i to( f�XC�'.\ St o r g v 1 City: 5 , r LbLAi s Pa r k-
.
State: VY Zip: h 5`-1 Lr Phone: C1 G J 2,_q 15--' c ? L
License #: C. 1 ' Q . . ()t.)1 0 50 Lead Certificate # : N ' A T — - 5 0 3 q " 1
If the project is exempt
from lead certification, please explain why: (see Page 3 for additional Information)
i 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 fora similar plan based on a master plan?
yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
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 12:37PM Sela Accounting
City of 8apn
3830 Pilot Knob Road
Eagan MN 55122
Phone; (651) 675 -5675
Fax: (651) 676-5694
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
Applicant's Signature _ /
9ra,2 ^�l)G,- -
No 1661 P. 11
Use BLUE or BLACK Ink
For Office Use
Permit #: /O `5 '-7'
Permit Fee: c° - ' 6
Date Received:
Staff:
ti J
Date: sJ I /; 7 Site Address :1536 153 / ,153 GreenUod C* . (Untt #:
CALL BEFORE YOU DIG. Calf Gopher State One Call at (661) 464 -0002 for protection against underground utility damage. Call 48 hours
before you Intend to dig to receive locates of underground utilities. www.gopherslateonecaU.orq
1 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 undersland this Is not a permit, but only an application for a permit, and work Is not to start wllhout 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 plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State suilding Code must he completed within 1130
days of permit Issuance.
x ) r In €1— 4-
Applicant's Printed Name
Page 1 of 3