1533 Greenwood Ct NRESIDENT /
OWNER
Name: ' l- ■ •'t ■ l -- N u'me_ `.aGC C_ Phone: ( )S -&31 - I 1 3
Address /City /Zip: (ok] ;S" C-�'T\1 L) —'+ 1'clr -K� y ���� t\ - 1r c� r
E :%11 V.n Q(Acr \ 'e , 'fl r1 t 5 3 V
Applicant is: Owner Contractor
TYPE OF WORK
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Description of work: Ce `rbC)
p
Construction Cost: ) ? (,) 9 51 0(0 Multi- Family Building: (Yes I No )
.
CONTRACTOR
Company: S ( Ct (ZOO - ci s h g R,01Da-e_i 1 in C1 Contact: 1.<av -r i~
J
Address: L i i06 �.XC_ � SI or g V c L City: S , t! ,uLAIS Pa i�k
State: YY11'\ Zip: 5 5.11 (v Phone: CI u J;,...—q 15 -- — 7 0_,7.- L
License #: C IQ ()DI 0 5 0 Lead Certificate #: NAT - a a U 3 LI — 1
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
Yes . No I f
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 the City to
conclude that the are trade secrets.
Aug. 1. 2012 12 37P Sela Accounting No.1661 P. 14
Use BLUE or BLACK Ink
Date:
C!ty of 8a�a�
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 676 -5694
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
For Office Use
Permit #;
/
Permit Fee: `7 —_'
Date Received;
Staff:
c' I / j - Site Address; 1531 , 1531 Greenwcocc Untt #:
CALL BEFORE YOU DIG, Call Gopher state one cell at (651) 464.0002 for protection against underground utility damage. Call 48 hours
before you Intend to dig to receive locates of underground utilities. www,gonhersj(eonecall.orq
I hereby acknowledge that (his Information is complete and accurate: that the work will be In conformance with the ordinances and codes of the City of
Eagan; 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 plans.
Exterior work authorized by a building permit Issued In accordance with the Minnesota State Building Code must be completed within 180
days of permit Issuance.
x a r Yl ' -fir lti'e r
Applicant's Printed Name
x
Applicant's Signature
Page 1 of 3
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