4170 Running Brook Rd41\tAt 4110, 411P,
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City of Eapll
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Date: (
Tenant Name:
Use BLUE or BLACK Ink
For Office Use
Permit #:
It3(04-1
Permit Fee: -714i.19
Date Received:
Staff:
2013 COMMERCIAL BUILDING PERMIT APPLICATION
ZD Site Address:L(1(A Lt 14'1-01) 14r74 / 47014\781) 130 ,47
ExiY4IL rs\Yi#: 4611x* --
(Tenant is: New /
Former Tenant:
Name: Phone:
Property Owner
Address / City / Zip:
Applicant is: Owner
Description of work:
Type of Work
Contractor
Contractor
Construction Cost: 6 ,
License #: ito/t.A.;
Name: ILA
Address: e't r City:
State: Zip:
Contact:
1
Phone:
LC,
/
Email - — (/`,4,-/ / e—ee11 /
Name: Registration #:
Architect/Engineer Address: City:
State: Zip: Phone:
Contact Person: Email:
Licensed plumber installing new sewer/water service: 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.
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.gopherstateonecall.org
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 reeuires a review and approval of plans.
X V
Applicant's Printed Name A(51nature
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lir. City of Eaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
ForOffice Use
Permit #:
Permit Fee:
Date Received:
Staff:
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Ru P - k
Date: 02'-' / / Site Address: Ii 7
(� nr- i)-7n60r)
Tenant:
RESIDENT / OWNER
TYPE OF WORK
CONTRACTOR
Name:
Suite #:
Phone: /e/7 sf / 57
Address / City / Zip:
Applicant is: Owner
Description of work:
Contractor
�Dft fZ�`i tv� 2), R PLl9C
Multi -Family Building: (Yes
Construction Cost:
/No_J
y� r- LL -- License #:
Name: ere3 f �
Address: 0 a392- //oPe-/1 diq (e
City: CA -Kt Jfr1 7 ,42 r'1
` i
Phone: i'5/ ` L/6 ) �% 8/ Contact Person:
fe 14)
State: Zip: 3-'6e)c
3 aH /717-erm e5/s2 me) v:5
COMPLETE THIS AREA ONLY W CONSTRUCTING A NEW BUILDING
Minnesota Rules 7672
® New Energy Code Worksheet
Energy Code
Category
(Al submission type)
In the last 12 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:
Mechanical Contractor:
Minnesota Rules 7670 Category 1
• Residential Ventilation Category 1 Worksheet
Submitted
• Energy Envelope Calculations Submitted
Submitted
Phone:
Phone:
Phone:
Sewer & Water Contractor:
NOTE: Plans` and supporting documents that you submit are•considered to be. public information: Portions of
the information may be classified as ne07PabitC1-4 yOd provide specific reasons that would permit the City to
concludes that they areitr"ade secrets,
1 hereby acknowledge that this information is complete and accurate; that the work wand ill be inrk n nfnot to start with
the ordainances permit; that and codes
of k the
City oin
a
Eagan; that I understand this is not a permit, but only an application forpermit,
:,ccordance with the approved plan in the case of work which requires a review and approval of plans.
. 411.110
jc�lcir�Z x �► "
Applicant's Signature
Applicant's Printed Name
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