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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