2192 Rocky Rapids Way
7Y
poC Office Use
I
Permit I
400 I
I Permit Fee: I
City of EqO
I I
3830 Pilot Knob Road I
I Date Received: I
Eagan MN 55122 I I
Phone: (651) 675-5675 I Staff:
Fax: (651) 675-5694 I I
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: " a "1 J Site Address:
Tenant: (g /aGt-" Suite
(~f' l t"-
RESIDENT/OWNER Name: Phone:
Address / City / Zip:
Applicant is: Owner -Y- Contractor
TYPE OF WORK Description of work:
Construction Cost: Multi-Family Building: (Yes/ No
d ~
CONTRACTOR Name: License
Address: ~3 2- , X17 e2 ~
lLr'Ir !52 State: /7f Zip: 5boa
City:
Phone: G";1,5/ Contact Person:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
_ Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672
Energy Code . Residential Ventilation Category 1 Worksheet New Energy Code Worksheet
Category Submitted Submitted
(4 submission type) • Energy Envelope Calculations Submitted
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: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans'and supporting'documents that you submit are considered to be public information: Port%ons of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that the are 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
^ccordance with the approved plan in the case of work which requires a review and approval of plans.
X ~G~~ ltGG/'/~Z x
Applicant's Printed Name Applicant's Signature Page 1 of 3