3425 Golfview Dr Unit 102RESIDENT OWNER
TYPE OF WORK
CONTRACTOR
Energy Code
Category
(4 submission type)
Applicant's Printed N me
City of Evan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
D om.
Date: g. 0 O 0 9 Site Address: 3 6
Tenant 2/
iLJL 61144
Name: Phone(6r/ littg —c-9 9.
Applicant is: Owner V Contractor
Address City Zip:
Description of work, r ,,.:..Ill
Construction Cost: 1 4 g O
Name: 17171/ i. _►rim' i w
Address: &t.4'
City: A
Phones) 7 g l e 0 2 6 �t% Contact Person:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Category 1
Residential Ventilation Category 1 Worksheet
Submitted
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:
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. permit; that the work will be in
accordance with the approved plpn in the case of work which requires a review and approv r ef plans.
x
Applicant Signature
r
Permit
Suite
Permit Fee: C 1 0
Date Received: SEP 2 9 2009
Staff:
Multi- Family Building: (Yes No
License
State: Zip: 55 9'
Minnesota Rules 7672
New Energy Code Worksheet
Submitted
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