4594 Maple Leaf Cir
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For Office Use
City of Ea Permit b ~ lQ ~
au
E Permit Fee. ~a o
3830 Pilot Knob Road I of
Eagan MN 55122 Date Received: G I
Phone: (651) 675-5675 I
Fax: (651) 675-5694 Staff:
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
C~ L1.59 Map(, Le tf Circle, Lzticn MN 55(2-3
Date: ) 1 3 (-1 Site Address: 459 N'V ip G" J c C N~ N S5lZ3
Tenant: T xr t-~) U C%t r, Suite
RESIDENT/OWNER Name: -W N \u S" ~ i'. Phone:
Address / City / Zip: /
Applicant is: Owner I/ Contractor
TYPE OF WORK Description of work: T-~cir ocf- r P~ i2
9 A,-
Construction Cost: ~f-`~ Multi-Family Building: (Yes / No
CONTRACTOR Name: R Qoc 1'1g License
Address: q q l
City: & + h S ~Ct~,1 State: __~l Zip: 53075
Phone: (S, 5 Lf 7 I ( Contact Person: Jc
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 a 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 the case of work which requires a review and approval of plans.
x lt~ ~l lxxi 2 x
Applicant's Printed Name Applic nt's Signat e
Page 1 of 3
CITY OF E'AGAN WATER SERVICE PERMIT
3830 Pilot Knob Road
P. O: Box 21199 PERMIT NO.•
Eagan, MN 55121 DATE:
Zoning: _ _ No. of Units:
Owner: _
Address:
Site Address:
Plumber:
Meter No.: Connection Charge:
Size: Account Deposit:
Reader No.: Permit Fee:
1 agree to comply with the City of Eagan Surcharge:
Ordinances. L, Misc. Charges:
( Total:
By Dote Poid:
Date of Insp,: In
CITY OF EAGAN SEWER SERVICE PERMIT
3830 Pilot Knob Road
P. O Box 21199 PERMIT NO.:
Eagan, MN 55121 DATE: _
Zoning: No. of Units:
Owner:
Address:
Site Address:
Plumber:
agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
By Misc. Charges:
Dote of Insp.: Total:
Insp.• Dote Paid: