4462 Glen Echo Bay
CIO 1~
r----------------
I For Office Use
I
I 210
Permit
City of a I-
I Permit Fee:
3830 Pilot Knob Road I I
Eagan MN 55122 1 Date Received:
Phone: (651) 675-5675 j Staff:
Fax: (651) 675-5694 I _ _ _ . _
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: ? -5- r7 Site Address: 2 ,
Tenant: Suite
RESIDENT / OWNER Name: Phone:
Address / City / Zip:
Applicant is: Owner Contractor
TYPE OF WORK Description of work:
Construction Cost: Multi-Family Building: (Yes / No
/ ~s r
CONTRACTOR Name: L ) / 1 s' l ~'~L c'LO_ License
Address: /z',) f2 .--aGl7/7'/f `'t J fG
~i/ State: H14 Zip:
City: / ~(~I`: wL"11-~/
Phone: / 2- 6i Z-0 Contact Person: el l 6g ~5cA
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, Portions of
the information may he classified as nor-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
Iccordance with the approved plan in the case of work which requires a review and approval of plans.
Applicant's Printed Name Applican 's Signature
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