4715 Oak Cliff Dr - Site Survey
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For Office Use ~(9
Permit
City of Eaaali
I Permit Fee: v I
3830 Pilot Knob Road I
Eagan MN 55122 Date Received: Jr'c
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 1 Staff: U
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: /.0 Site Address:
Tenant: Suite
RESIDENT/ OWNER Name: & ( f»a4ft M Phone: •a
Address/ City /Zip: T l o t C /'~yl G - G g r`
Applicant is: Owner Contractor
TYPE OF WORK Description of work: Gj Z
Construction Cost: ck:'o Multi-Family Building: (Yes /No ^ay~ `G License ago sir?
CONTRACTOR Name: .411412f -
Address: 14(0tr
City: State: 4f,v Zip:
Phone: pM2.. J/^7 Contact Person: /1 ;
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Category ry 1 _ Minnesota Rules 7672
Energy Code • Residential Ventilation Category 1 Worksheet New Energy Code Worksheet
Category Submitted Submitted
(4 submission type) • 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:
NOTE; Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
I hereby acknowledge that this information is complete and accurate; that the work will be in conf+ r nnn- 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 is not to start wi ermit; that the work will be in
accordance with the approved plan in the case of work which requires a review and ap oval of plans.
X 6 1 x
Applicant's Printed Name Applicant ' Signa re
Page 1 of 3
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