4464 Glen Echo Bay
CIO 1~
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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
Page 1 of 3
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. .. . ' . , ' . . � ' . . Use BLUE or BLACK Ink ,,�
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. � ' i F0�Ott�Ce USB � �
Cl U . . j Permlt tt: � � 'V�� j
y of �� aIl � a�- �
� . � PBrmit Fee: �� �
3830 Pilot Knob Road . � � i
Eagan MN 55122 ' ' j Date Received: � �;,
Phone: (651) 676-6676 i �
Fax: (661) 676L5694 i stan: i
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2011 RESIDENTIAI. BUIL�DING PERMIT APPLICATION
Date: Site Address: .. � � � Unit#; ' �
Name: ' / �`�1F�1�d'� .. ��C�.��1/1•. . '.� Phone: �'��— `7J�"c�.��
RESIDENT/ ;n
OWNER Address r city i zip: ��l(D� � ���°� �� �1Cp � p�
APPlicant(s: .Owner ' Contractor. :
TYPE OF WORK DescripUon ofworic:_ �_1'�E�G!-�'l�— C�i��faT �Q�L1
/,�1��t^, �
Construction Cost: � �(Y��d � Multi-Family B iiding: (Yes��No_,�
,
Company:''�t✓en9'C� (���(� �� � Contact: .Sfe��° ��a�����. ;,�
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,
CONTRACTOR Address: ��P�� if�it/��jUE ,IQ�i ' ,City: _ �P�.._� i
Siate: �N• Zip; �5��.�� Fhone: '�S/�- d 9 Y=���d �
ucense�:_ �-�D.'>S OD,�'�-�- . l.ead:CertJflcate#: /1/`�4,7— �,Z„�'� 3�/ I
If the project is exempt from 18ad certlflcat(on, please e�laln�wh.y;.:(see.Page 3 for additional information) �
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COMPLETE 7HIS AREA QN�IF CQN3jR�1CTING A NEW BUILDING
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In the last 12 months, has the Clty of Eagan lssued a permlt tor.a slmi)ar plan based on a master pian7 �
TYes _No if yes,data and address of master plan: � I
�
l�lcensed Plumber: • Phone: f
i �
I Mechanical Contractor: ' Phone: ;
i
� Sewor 8 Water Contractor. ' ' Phone: �
NOTE:Plans and supporting document,s tha#,you:subm,if are.cpns7�fered,ta�be publlc lnformadon. Port/ons of
the lnformatJon may be c/assJflecl��as�on-Rc(�11c:lfyvtl.p{'OYId,e'sp�Cl�lc r^aa�sons that would permlt the City ta
. ,:.conclud�'�fiat,the .�are trad�a.secr.ets. ,�: �
. .... .:..:....•..:.�,,,...: -
CALL BEFORE YOU DIG. CaA Oopher 9tatv Onv.Cal!e((ab,t)��b4-0OpY�pf p�ptec�lOn e981nst unde�round utlltty damage. Call a8 hours
belora you Inland to dJ9 to recelve locales o!undet�round uUllUei, Wwvr.sop(�rsteleonecall ora ..... .: :
i:r°,:�i�;.t;�;,^;t`r;:,•.�..
I Rereby acknowtedge Ihal lhis InfOfineUO(1 IS COfTlpi9l@ 8f1d BCCUf8l9;that the work rdU ba In,coniormancs wlth tha ordlnancas and codes of tna Ciry oi �
E2gan; that i understand lhis ls no! a p@rmlt, but oNy an appllC8Uof1 (or 8 p9m11t, ��1d„Wpfk {s,not to steft without e permit; lhal Ne work will pe in
accordance wilh lhe approved plan In lhe'case o(worfc which requlres a�avlew end approvai ot.piana,�
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Exte�io�work authortzed by a bulldlnfl permit Isaued In accordance with the Mlnnesota 8tato 8uliding Code must be completed withln 180
days of parmlt issuance. � • •
X �! c���r �����I 1 �! G'/-4 X / \ �.. � .
Applicant's Printad Name f
Ap cant's Slgnature
Paqe i of 3 ,�