834 Ivy LaneRESIDENT / OWNER
Nameg, ACT /4 AA/R6E*EXIT Phone: Ti, 3 -593 9770
Address / City / Zip: 85O IDFo TUR A.V6 N 44 2?r GOLOEIV .Au.Ey 55q27
Applicant is: Owner X Contractor
TYPE OF WORK
Description of work: 126 AND R PL 4GE R4OF
Construction Cost ' 9SOO Multi- Family Building: (Yes / No
)
CONTRACTOR
Name: iE I Erre M141Al(' cal? License#: ZO2 '/ 3 //
Address: 7O s t ( ) . 6071° 7 7 ' 7 7 e / Po tats
Cit /"'!t/WV
/ E�
State: N / S'sli f Phone: 1 /2 - 24 I _ (� 2 (A.
PAUL.
Contact: Email: li(�' bG1)LM • C.OA1
COMPLETE
In the last 12 months, has
Yes No If yes,
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:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor:
,,
Phone:
rll 7i'm atl on. Porti
of
4 City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
Permit #:
Permit Fee:
Date Received:
Staff:
2010 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 5 72.5 Site Address: n14 ivy L A rjr
/0 00 873
Use BLUE or BLACK Ink
J
Tenant: Suite #:
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.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 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 9Ywork which requires a review and approval of plans.
x C#ictseLteAso.
Applicant's Printed Name
Applicant's Signature
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