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'Yell
1 For bWAce. Use
City o a Permit I
I Permit Fee:
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received; I
Phone: (651) 675-5675 j staff:
Fax: (651) 675-5694
200 RESIDE
NTIAL BUILDING PERMIT APPLICATION
/9,17 M37
Date: l Site Address: 11 r 11`~ f 24132r c'.• j' ItLk
rte.
i
Tenant: Suite
I
RESIDENT / OWNER Name: Phone:
i
Address / City / Zip:
Applicant is: Owner Contractor
TYPE OF WORK Description of world' xey~
i,
Construction Cost: E Multi-Family Building: (Yes / No---)
/
CONTRACTOR Name: ~
L~1 Y>/! j~~Y/ 1'7C'~ License
Address: /~~GGYt7rt2z°!'t f z~? ~G~
City: J: ?e~/~.~5 State: //I12t'I Zip:
Phone: Contact Person: ~"'7r /W~~
•
COMPLETE THIS ARE, ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Category 1 Minnesota Rules 7672
Energy Core Residential Ventilation Category 1 Worksheet New Energy Code Worksheet
Category Submitted Submitted
submission type) m Energy Envelope Calculations Submitted
In the last 'l 2 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE. Plans and sypporitin,gdocuments that you summit 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 the : aee,trade secrets.
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
,ccordanc/Iewith the approved plan in the case of work which requires a review and approval of plans.
x v~
App icant's Printed Name Applicant's Signature
Page