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3420 Golfview Dr Unit 221 E J11 1k, rrj, ` 00 ( boy Office us"' 70/ City of Eap Per1 ~aC I Permit Fee: 3830 Pilot Knob Road Eagan MN 55122 I Date Received: Phone: (651) 675-5675 ~ Staff: Fax: (651) 675-5694 - - - - - - - - - - - - - - - - - J 2008 RESIDENTIAL BUILDING PERMIT APPLICATION 16-4 , Date: l Site Address--34aL ~ c I Tom: ~ C~k~2k L Suite RESIDENT / OWNER Name: Phoneds7l)g0$+- q4, b M k) GIS R 3 Address / City /Zip: Y C?N~U"Ikkp o~ & / , Applicant is: Owner ontractor TYPE OF WORK Description of work: ,I L ors Construction Cost: i. 060 Multi-Family Building: (Yes No CONTRACTOR Name: License 17 D Address: ' O 1 City: ' State: -zip: Phone(S`1-7 X ` -.,~a 4 _ Contact Person: COMPLETE THIS AREA ONLY IF CONSTRUCTING 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 ordin nces 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 ermit; that the work will be in accordance with the approved plan in the case of work which requires a review and appr al tans. x X 4 YIA, - - Applicant's Printed me Applicant' Signatur Page 1 of 3