4494 Cinnamon Ridge Tr Unit ARESIDENT /OWNER
�/ �/ Phone: / 8 gD.5J ?t.
Name: R,40,.. P� (Q' n- �C f t u el
Address / City / Zip: T / 7 L/ (/ /) / n M O n & C(ef -L 77 /
Applicant is: Owner ` Contractor
TYPE OF WORK
Description of work: 2 w/ n d U w Pi p In l nu 4-/f- f R /X/11/A7 Op I
Construction Cost: ` J Multi- Family Building: (Yes / No )
"11-113 Inc.
CONTRACTOR
At- Horne Services,
Name: 2690 Cumberland Pkwy, Ste 300 _ License #:
Cumberland Office Park
Address: City:
— Atlanta, GA 30339 -3913
State: Lic# 20268257 Ph. 763/ 542 -8826 9 6-/341 C - GO (,/?
Contact: J bek Email: 0 d i S et P /tYP!'- 0 n e S .to cv
a
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 for a 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
the information may
documents that you submit are considered to be public information. Portions of
be classified as non - public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
•
x 7iM 51/S/n4
City of Eaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
Applicant's Printed Name
2010 RESIDENTIAL BUILDING PERMIT APPLICATION
�• ( 4441 Date: 3 ` 1 Site Address: ` L I C / n m 0 , 4 ,Q, 0/9e, -77
Suite #: 1 " ) -/ A
Tenant: f 7t a 00 A (-1 f'i 0
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.00pherstateonecall.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 of work which requires a review and approval of plans.
Applicant's Signature
Use BLUE or BLACK Ink
For Office Use
Permit #: B f 6
Permit Fee:
Date Receive
Staff:
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