1282 Timbershore LaneRESIDENT J OWNER
Name:741+ 4.,ilr._- / 'i 62✓ /14'4G'c Phone:
50C--1 -
Address !City !Zip: �V
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L.
Applicant is: Owner Contractor
TYPE OF WORK
Description of work: L
/ 7 -
Construction Cost /4) SI 7' M '- amity Building: (Yes a' ! No )
CONTRACTOR
Name, trt 1 . us01.47 l' .r License #: 6 7 q..,
_oz
Address: .. ;511 D ode-9 ($(/r 1-it City: t r , ArreaciA
��� , -557 4 (Z- 7z 3r- t - f...(
State : c3 y Ph ne:
y Zip:
_ 4-1
Contact: 73. £4- [.-t -- Email: 1 ' - _7nii4# vim, f'4
COMPLETE
In the last 12 months, has
No If yes,
THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
the City of Eagan Issued a permit fora similar plan based on a master plan?
date and address of master plan:
_Yes
Licensed Plumber: Phone:
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 My to
conclude that they are trade secrets.
Jul 12 10 08:14a Gates General Contractors
41 City of Eapll
Tenant:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675-5694
Appii s Printed Name
Applicant's Sig nature
(763) 498 -7710 p.5
For Office 7
Permit Fee:
Use BLUE or BLACK Ink
Date Received:
Staff:
J
r 2010 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: i(i i 0 Site Address: _.a1 Z80 '
Zera 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. Iwww.copherstateonecali.org
hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances • • codes of the City of
Eagan• nderstand this is not a permit, but only an application for a permit, and wo . ' rP to start without a perm i hat the work will be in
acco = an.y' h the approved plan in th a e of work which requires a review and ap
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