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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 Page 1 of 3