1863 Michael Point Dr
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For Office U. se
City of EaPH I Permit A
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3830 Pilot Knob Road Permit Fee: ~
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 1 staff: 1
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2008 REST ENT'IA UIL®ING PERMIT APPL ATION-^-----
Date: r ! `7' Site Address: fzL`~ _ J o /glc /Z
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Tenant:
Suite:
RESIDENT" / OWNER Name: Phone:
Address / City / Zip:
Applicant is: Owner Contractor
TYPE OF WORK Description of work: _ T} xeo 7a
Construction Cost:
i Multi-Family Building: (Yes- / No
CONTRACTOR Name: A ~I ~-5' ~'~Jr7 14 7-5~tr7Ce' License
Address: 7 GtYf'7 Z~'!' > r~ ? -Q 1
State: IV41 Zip: , ~-J I13
43
Phone: 82 Contact Person: > >
COMPLETE THIS AREA ONLY IF CONSTRUCTING NEW BUILDING
` Minnesota Rules 7670 Category 1 Minnesota Rules 7672
Energy Code Residential Ventilation Category 1 Worksheet New Energy Code Worksheet
Category Submitted Submitted
N submission type) Energy Envelope Calculations Submitted
In the last 12 months, has the City or 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 supposing documents that you subm are considered to be 'public inforrr~afion Portions 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.
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 {
agan; 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 p ns.
.pplicant's Printed Name Applicant's Signature
Pagel of 3
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