1947 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
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