1863 Casey Tr
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For Office. Use I
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; Permit
City of a
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I Permit Fee: I
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 ; Staff: I
Fax: (651) 675-5694 I 1
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Late: 5ite Address: - Ci ZcG'''
Tenant: Suite
RESIDENT / OWNER Name: Phone:
Address / City / Zip:
Applicant is: Owner Contractor
TYPE OF WORK Description of work: / 1~- 7a
Construction Cost: Multi-Family Building: (Yes No
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CONTRACTOR Name: e) T/ Z°-~~ Xy,1,k-7 ~C License G= 2 ~ ~
Address:q 21z9a -:Y/ /GG1't7f ~ 7u le
City: - d/.I f?l?/~. a State: Zip: J:~'1'
Phone: 912- t 38"/~
/ `~LuG~,G;-~ 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
(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:
MOTE Plans and supporting documents that you tibmit are considered to he'public information Portions of
the information may be classified as non-public ii you provide specific reasons that would permit the City to
conclude_that the are trade secrete,
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 i
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
,,ccordance with the approved plan in the case of work which requires a review and approv
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Appl cant's Printed Name Applicants Signature
Pag 3