1276 Timbershore LaneRESIDENT /OWNER
Narne: ` Jr_ : •�...: h ' Phone:
raid ...
Address / City J Zip:
' /
Applicant is: Owner / tractor
_._
TYPE OF WORK
Description of work: .!
Construction Cost: i 116 Multi - Family Building: (Yes , f No )
CONTRACTOR
Name: 'edit rt ..4# IA.. r %1 ;) License #: 4/i `? 9;
,.Li
7 �/'� /
�
Address: S �J l�IC. sue, L 1 ✓ City: V
State: I' /Y Zip: 5:5 Frn KCia -557 4 rt.- 74 _/93 f
_
Contact 3 rE (--- 6 ` Email: mi l! t/4 -6'' 7 f7e,� T rj
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: Phase:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions 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.
Jul 12 10 08:13a Gates General Contractors
Cite of Eaaali
Tenant:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
( 4 GG J
Apple 's Printed Name
x
Ap . ' nt's Signature
(763) 498 -7710 p.1
Use BLUE or BLACK Ink
For Office Use (�
Permit #: f
Permit Fee: 30 e
Date Received:
Staff:
� 2010 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: r ( I 2 r � t� Site Address: /2-7g-/r2 Y j I `Z 70 /z-7J I r d"4 541.471 -1- 6 "
Suite #:
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage.
CaII 48 hours before you intend to dig to receive locates of underground utilities. Iwww_gor herstateonecall.org I
I hereby acknowledge that this information is complete and accurate; that the work will be in conforma • with the ordinances 'nd codes of the City of
Eagan; tha derstand this is not a permit, but only an application for a permit, and work is o start without a perm' , t the work will be in
acco ce w' the approved plan in of work which requires a review and app
Page 1 of 2