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