4698 Lenore LaneCity of Eagoi
Tenant:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
Date:
RESIDENT / OWNER
TYPE OF WORK
CONTRACTOR
Energy Code
Category
(4 submission type)
idAr
App'icant's Printed Name
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
Site Address: L 4 ( O 1-�c�J
Name: \ cxY\
' ^
Address / City / Zip: 4 c O (.0 p Le.YA 0 ( ,
A
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7/4
Applicant is: Owner
Description of wor
Construction Cost:
Name:
ontractor
Address: 'q0 LOIle
City: c )�
Phone: C[ (70 0),F
Minnesota Rules 7670 Category 1
• Residential Ventilation Category 1 Worksheet
Submitted
• Energy Envelope Calculations Submitted
NOV 202009
Contact Person:
■
r
Staff:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
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:
Date Received:
Suite #:
►.' /.i
Multi - Family Building: (Yes / No
License #: " 1 ('p (-('�
State: P'ip: c t
Minnesota Rules 7672
• New Energy Code Worksheet
Submitted
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 plan in the case of work which requires a review and approval of plans.
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
'
Signature
Page 1 of 3
m , IAFAT*
W AR* . PERMIT NO.: j l ci /
RIII i*io. of u nits: 1 .unit "tnhse
- Orrin Thomps6iiJOmees.
4698 Lenore Lane L3 B1 R .dgecliffe xV
Gene Ryan
Connection Giorgi: 335. pd
A°°o`mt Deposi 10.00 pit
Permlt fee:
1 e ii f ewe a 4w" Serge: . 50 Pd
Misc. Charges:
. 60.00 pd meter
Total:
By .ir•.' .AAD !as Paid:
o �.�� !, ice+.:
. PERMIT No - , 4694
�'�tGa t y . 10 O1 1 *
R 9
i of v omits: �
a .rin Tkia { . :�: ernes
Add ress: ', en Lane 41Ic B , g iffe ''r""'�R.
ste er: Germ Rvan i u ' - I.
3/24/81 23867 100.00 pd
1 wipes gamma* watt eL• clay of News Connection Charge: 425 .00 Dd E
Account 1
P'eropit Fee: 10 _no r ut
i Surrifongs: SO P�
Date r Misc.
=. � f
i ; Total: Or Date Paid: