3420 Golfview Dr Unit 118 i
0D
r-----------------
For Office Use Permit
City of Ea
Permit Fee: e? o co
3830 Pilot Knob Road
Eagan MN 55122 Date Received: I
Phone: (651) 675-5675 I
Fax: (651) 675-5694 Staff:
I
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: f 1' C1 / Site Address: ~J U."aw 4f- t 12
Suite
f
RESIDENT /OWNER Name. Phone(bS'`7 1 43 -1 Rig a
Address / City / Zip:314 tD 'L-t.LLO
Applicant is: Owner Contractor
TYPE OF WORK Description of work:
UU e~~ eS
Construction Cost: ( 000 Multi Family Building: (Yes / No
CONTRACTOR Name: License
Address: 74 O1~i-Y
City: if e~Qjzz~ State: ,1) Zip:
Phone: (,5) L 64- a Ia L/6 Contact Person:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A W 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 or finances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, an¢ rk is not to start without permit; that the work will be in
accordance with the approved plan 'n the case of work which requires a review and app oval f plans. ~~AJ_4
x ~ t(_L x
Applicant's Printed Na a Applic n s Signatur
Page 1 of 3