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1945 Jan Echo Tr i I ForOffice:Use I City 0 ~ Permit Eali n I D I I Permit Fee: [ 3830 Pilot Knob Road Eagan MN 55122 Date Received: j Phone: (651) 675-5675 I I Fax: (651) 675-5694 I Staff: I I I 200 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: 11410 Iq / 4 Tenant: Suite RESIDENT/ OWNER Name; Phone: Address / City / Zip: Applicant is: Owner Contractor TYPE OF WORK Description of work: I Jc-G~fl -142 Construction Cost: Multi-Family Building: (Yes, /No CONTRACTOR Name:. e) Z--!!5 IVIf CtE License Fes- Zzlz) Address: ? IG~ SLCI '7 i' . w~ z l If 2YO City: Aili7je-/l/a,21",~5 State: ft~/ Zip: J. 11,..._ Phone: 1-a12-,381`,` 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 submission type) Energy Envelope Calculations Submitted In the last 12 months, has 'he 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: Sender & Water Contractor: Phone: NOTE: Plans and supporting documents that you submit are considered to be 'public information. Portiohs 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. 1 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 approval of plans. ^ccordance with the approved plan in the case of work which requi:77X x~VV L. VVL1 Applicant's Printed Name Applicant's Signature Page 1 of 3