1537 Aspen DrRESIDENT !OWNER
Phone: 9 5 A e lm - 5 ..,
Name: �a-�//
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Address / City / Zip: (.p`�"�. X (',�f i) 7'.-04 i JM 7J C,fJC
Applicant is: Owner Contractor c5 ,,, f
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TYPE OF WORK
Description of work: ''/d 1 r At:
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Construction Cost '" /3 (a 00 Multi - Family Building; (Yes X 1 No )
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CONTRACTOR
S i1 License*
Name: - D License ODD 1O5 D
Address: I Z .ice_ ,. _ Livi # t Cit - L J `ci 7
State :! W Zip: . r (.e A Phone: — ''� l `6
Contact:c r'/"l Vic /v1 Vlr✓L. -L mail: i /� 1 add ...
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:
Sewer & Water Contractor:
Phone:
Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portion of
the information may be classified as non public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
Jun. 1. 2010 4:O0PM SELA ROOFING No. 1929 P. 2
4, City of Earn
Date:
Tenant:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
2010 RESIDENTIAL BUILDING PERMIT APPLICATION
Site Addreiss:
Applicant's Printed Name
/6 3 7
,or r5.ffice use
Permit #:
Permit Fee:
Date Received;
Staff.
Use BLUE or BLACK Ink
qLi
-7
Suite #:
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.00�herstateonecal) 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
> agan; that I understand this Is not a permit, but only an application for a permit, and work is nOt t0 Start without a • - that the work will be in
accordance with the approved plan in the case of work which requires a review and approv +; plans.
x
Applicant's Signature
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