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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 Page 1 of 3