2185 Cool Stream Cir - BL 89377
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I For Office Use
Permit /
City of EaV~ d
Permit Fee:. '
3830 Pilot Knob Road f/
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I
Fax: (651) 675-5694 Staff:
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: _ Site Address:
Tenant: Suite
RESIDENT/ OWNER Name: Yil _/zqN.I~ Phone: ~S~ ~C
Address / City /Zip: 6~r2cA;D AzT- 141 Ste. Si &uL /V, 55 O 7
Applicant is: Owner X Contractor
TYPE OF WORK Description of work: RE/UO 4/!ID j2672(, ( 5 c~/4'2 -
Construction Cost: Multi-Family Building: (Yes / No
CONTRACTOR Name: 7X( t0f /1t,4f1VT C~c /2 License
Address:4"Os /1 6c Srii
City: _yl11211'Inkloot 15 State: Zip:
Phone: 61 Z4 6"? ~3 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 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 be classified as non-public if you provide specific reasons that would permit the City to
conclude that they 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 permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in he case of work which requires a review and approval lans.
x C%V[ S 1'
Applicant's Printed Name Applicant's Signature
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