3420 Golfview Dr Unit 222City of Eaaali
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
RESIDENT OWNER
CONTRACTOR
Energy Code
Category
('1 submission type)
Applicants P inteame
Name: Q
Address it Zip:3 `A 0
Applicant is: Owner Contractor
Address: L/7 `t
City: CY/AA 0 c Cc*_ J
Phone:((ogl /7 011-014 Li 6
Description of work:
Construction Cost 0(2
Minnesota Rules 7670 Category 1
Residential Ventilation Category 1 Worksheet
Submitted
Energy Envelope Calculations Submitted
vtik
State: Zip:
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: /40' a 2• 07 Site Address: .3 p
Permit l j 9
Permit Fee: C /0` 0
Date Received:
Staff:
Tenant: Suite
Phone6 q5 q
Multi Family Building: (Yes No
Name: 81'vt -6 License 7 Lie
Contact Person:
COMPLETE THIS AREA ONLY IF CONSTRUCTING °NEW BUILDING
Minnesota Rules 7672
New Energy Code Worksheet
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 permit; that the work will be in
accordance with the approved an in the case of work which requires a review and approval of plans.
x
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