1442 Yankee Doodle RdCity of bop
Date:
Tenant:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
Staff:
Use BLUE or BLACK Ink
Permit #: ' 305
Permit Fee: 90 e 0 0 V
Date Received:
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2010 RESIDENTIAL BUILDING PERMIT APPLICATION
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RESIDENT / OWNER
TYPE OF WORK
CONTRACTOR
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Applicant is: X Owner Contractor
Description of work:
Construction Cost: Multi- Family Building: (Yes / No )
Name: V ► C License #:
Address: City:
State: Zip: Phone:
Contact: Email:
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In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
Yes No If yes, date and address of master plan:
Phone:
Phone:
Sewer & Water Contractor: Phone:
Licensed Plumber:
Mechanical Contractor:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
NOTE: Plans and supporting documents. that you submit are considered ,to, public information. Portions of .
t he information may be classified as non-public if you prov ide speck reasons a hat wound permit the City to
conc lude: that they are trade secrets.
BEFORE YOU DIG. CaII 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.aopherstateonecall.orq
I 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 understand this is not a permit, but only an application for 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 approva of plans.
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Applicant's Printed Name Applicant's Signature