3420 Golfview Dr Unit 221
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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
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2008 RESIDENTIAL BUILDING PERMIT APPLICATION
16-4 ,
Date: l Site Address--34aL
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Tom: ~ C~k~2k L Suite
RESIDENT / OWNER Name: Phoneds7l)g0$+- q4, b
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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: '
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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
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Applicant's Printed me Applicant' Signatur
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