3425 Golfview Dr Unit 318C!ty of No
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
Date: L / 4 ' 1d Site Address: 3
CONTRACTOR
Applicant's Printed
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
Address / City /
Applicant is: Owner _ Contractor
Description of work: 05
Construction Cost: c2 , !o
APR 28 2010
.961
Phone:6 S'J 7 g 4 44 Contact Person:
Permit #: 1 3 t , / t1
Permit Fee: qo ° 50
-
Date Received:
Staff:
Use BLUE or BLACK Ink
J
Tenant: Suite #:
x
Applica
Gtf.. ALet 1 - Vth ,Akektte cizt-ixte
Multi - Family Building: (Yes / No ) )
Name:
C W ± orr) E1,kp License #: ` 1 S
Address: ( V7 1- /
City: AMP QlCr:</G
State:TJn• Zip: 45 6 ) / V
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
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:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
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.gooherstateonecali.ora
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 a permit, and work is not to start without a / permit; that the work will be in
accordance with the approved plan • the case of work which requires a review and approval of plans.
x 6 l
a S'gnats
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