3420 Golfview Dr Unit 121RESIDENT OWNER
TYPE OF WORK
CONTRACTOR
City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
!TE. Plan and S11 o ngodd a is
e in orm on m ay a cl ssrfieed as o
Site Address:/' D
Name
Address: L7 4
City: �U1 U)
)nc%ude t a hey r.,'e tradesec
ysub are C E O 51iere
rf o uprov e p ec i c
x
License
Applica J- Signature
State:J Zip:
Permit
Permit Fee: 0- 0 V
Date Received:
Staff:
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
Suite
Name:, /t. L Phone(Si) L6
Address City Zip: 3 Az) 74 SS /off
Applicant is: Owner X Contractor
Description of work: dI J-inteltd GU- c.4tie1-01- 1 pale) Baal
Construction Cost: 5, c D
Multi Family Building: (Yes No
Phoney �P 7 2gS (2-40 40 Contact Person: _mil
1 1
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Category 1 Minnesota Rules 7672
Energy Code Residential Ventilation Category 1 Worksheet New Energy Code Worksheet
Category Submitted Submitted
('1 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:
a
fog
"!o
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 work is not to start without a hermit; that the work will be in
accordar with the approve plan in the case of work which requires a review and appro .f plans.
ions:
Page 1 of 3