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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 Page 1 of 2