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3425 Golfview Dr Unit 213 00 Ah6 I r----------------- For Offic„ Us Permit City of Eaall 7, Permit Fee: ld r 3830 Pilot Knob Road Eagan MN 55122 Date Received: Phone: (651) 675-5675 staff: Fax: (651) 675-5694 - - - - - - - - - - 2008 RESIDENTIAL BUILDING PERMIT APPLICATION Date: ' 1 I Site Address 4 wii_iAz Ako)._ 13 Pt Suite RESIDENT / OWNER Name• Phone/2c& S L1L 9 .spa Address/ City/Zip: Lt.L" Applicant is: Owner _ Con ractor TYPE OF WORK Description of work: _ Construction Cost: t , ~J Multi Family Building: (Yes _/No CONTRACTOR Name: /~j License / 7 4 ~3 Address:4-7 4 C~ A ~ City: /1 II vy z, LkfJ) St : M Zip: Phone:`(FS~t I 3q - o`(g 4 t' Contact Person: COMPLETE THIS AREA ONLY IF CONSTRUCTING A EW LDING 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 wok is not to start without a p mit; that the work will be in accordance with the approved pi in the case of work which requires a review and approv o laps. X 01 x Llu_c~ Applicant's Printe me Applican s ignature Page 1 of 3