1534 Aspen DrRESIDENT / OWNER
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Name: 6 ' 95 A q/.5 5
Phone:
Address / City / Zip: 698/y (?..4 -4 u), K._tcJGC. , r t'`J..4),�1.,.c,
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Applicant is: Owner Contractor
TYPE OF WORK
1
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Description of work: 1 r/'
, : % . ' • ++' � '. -ier� _ .1 1 �` AV J
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Construction Cost i ( 3/ is? oQ Multi- Family Building; (Yes X / No )
CONTRACTOR
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Name: 14 eti (fir /AJ& License* D /05D
Address: +/ V J_ . /__JJ • it - Lr
state:! Ul.f Phone: lei -' l '6 r
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/j,/;Zip
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Contact : 4 V fV VII--- email: f i. j � �
COMPLETE
In the last 12 months, has
_ Yes No If yes,
Licensed Plumber:
THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
the City of Eagan issued a permit for a similar plan based on a master plan?
date and address of master plan: ._
Phone:
Mechanical Contractor: Phone!
Sewer & Water Contractor:
Phone:
documents that you submit are considered to be public information. Portions of
be classified as non public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
NOTE: Plans and supporting
the information may
Jun. 1, 2010 4:0OPM SELA ROOFING
Cllpf}1aau
Date:
Tenant:
3830 Pilot Knob Road
Eagan MN 55122
Phone; (651) 675-5675
Fax: (651) 675 -5694
Applicant's Printed Name
2010 RESIDENTIAL BUILDING PERMIT APPLICATION
Site Address_ �� 3 1. ' _ r t C'
/532 53 , /5 -
No. 1929 P. 2
Use BLUE or BLACK Ink
Permit #; - / `I a, .L V
Permit Fee: / i 3
Date Received;
Staff;
CALL BEFORE YOU DIG. Call Gopher State One Gall 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.00pherstateonecall.orq
Suite #:
Page 1 of 2
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
agan; that I understand this Is not a permit, but only an application for a permit, and work is not t0 start without 2 i; that the work will be in
accordance with the d appproved / pian in the case ooff wor which requires a review and approv plans.
k C
x C5/444 Applicant's Signature