3440 Golfview Dr Unit 325
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City of 1a an Permit 7
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3830 Pilot Knob Road ;Permit Fee: • r~/Q I
Eagan MN 55122 Date Received: _ ` I I
Phone: (651) 675-5675 Staff:
Fax: (651) 675-5694 i
2008 RESIDENTIAL BU=UA'S_Az ERMIT APPLICATION
Date: r l• Q Site Address: 3LJ(-Iz) - /~A- s J
Tenant: Suite
RESIDENT/ OWNER Name: (}~--E2 Phone ws~ I
Address / City / Zip: Q~ 3~ S SJ ~a-3
Applicant is: Owner Contractor
TYPE OF WORK Description of work:
Construction Cost: _ 4,e) Multi-Famil uilding: (Yes No
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CONTRACTOR Name: Lim License f 7 4 a
Address: '47
1A -
City: AA e_4 State: 14 Zip:
Phone/ ~/)79644 Contact Person:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A EW B ILDING
- Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672
Energy Code • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
Category Submitted Submitted
(4 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 an codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work of to start without a permit; t t the work will be in
accordance with the approved Ian in the case of work which requires a review and approval f plan
X .
J ~ x /r,
Applicant's Print ame Applicant' nature
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