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1627 Hickory Lane For Office Use Permit City of Ea Rd I Permit Fee: Z6_1 3830 Pilot Knob Road I Ci_ Eagan MN 55122 Date Received: Phone: (651) 675-5675 Fax: (651) 675-5694 Staff: I 2009 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: li - I-/~CIC /`-j Tenant: r" L' t=tea; 'y~ i ? / Suite RESIDENT / OWNER Name: Phone: Address / City / Zip: Applicant is: Owner Contractor TYPE OF WORK Description of work: / C F ' Construction Cost: Multi-Family Building: (Yes) / No - ?~C C f i n- t %'0 CONTRACTOR Name: License ~ / Address: / 9/~ //C- )/f 'T /f~ G/_ jC ?~~J/ \ n City: I % t 1 LL State: /11 Zip: 3 Phone: 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 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 f plan j jL X ~j(_( 4 0 1111- C-11 (C'S % -44 A2 x Applicant's Printed Name Applicant's Signa re Page 1 of 3 øïø ÿú þý ýü þýý ü üúú ùýý úÿêø÷é ö ý ä ÿ þýø ûúùø ðû ý õ ó ö á ì ðû ý õ ó Úû ý ýø í ñû í îû âý ü ý þ ýø üÝ åÜ ý åä âþ çååêäêää öù û îý çåê ê å õ ô øóò øøý û ã ý õ áýîýèý ø åö û ã ý ß ùý û þý ýâáååå Ý åÜä å î ùýì îýîýã ýîýøøýýý îýî íý ýý íøùìîýýøøý ý â ý ýû ýóùþý ýï ý ê øøýë í ýû û ù ýû mu = Of EAGAN WATER SERVICE PERMIT 315 Pih t Knob Rood PERMIT NO.: 1444 Eagan, MN 55122 DATE: 4/26/74 Zoning: POD No. of Units: Owner: ibodgate. Hex Horizon Hoaxes Address: Site Address: 1625- 27 -29 -31 HickOy Tana Plumber: Thompson Plumbing Co. Meter No.• Connection Charge: Size: Account Deposit: Reader No.• Permit Fee: 10.00 pd 1 agree to comply with the Village of Eagan Surcharge: 50 pet Ordinances. Misc.-Charges: Total: By Date Paid: Date of Insp.: Insp.: VILLAGE SF EAGAN SEWER SERVICE PERMIT 3751 Plot Knob Road PERMIT NO.: 2204 Eagan, MN 55122 DATE: 4/26/74 Zoning: POD No. of Units: Owner: Woodgate , N ew Horizon Homes Address: • Site Address: 1625- 27 -29 -31 Hickory Lane Plumber: Thompson Plumbing Co. agree to comply with the Village of Eagan Connection Charge: Ordinances. Account Deposit: I ©.00 pd Permit Fee: .50 pd Surcharge: By: Misc. Charges: Date of Insp.: Total: Insp.: Date Paid: