3914 Valley View Dr NPROPERTY OWNER
Name: 06 ci1 �� L l^� Q F°honetlL�7 � ( 5 -p )
Address l City 1 Zip:U. i Lt I J (fit,(), f f J V t S \fit 4LL& , Cnr 'J 5IK C
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Applicant is: Owner V Contractor
TYPE OF WORK
Description of work: Q,1' Z ( I\ ) t \,(1,
Construction Cost
CONTRACTOR
Name OAP k__ \ .. ,` t j C 0 �, o. C icen.s #. Ci5
1
Address: l�' 1 rQ)kr' (1\14,S Cit Li f ! A. J
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State: Zip: l 1 Phone: l.v I i" l ?)-' 935t-i
Contact: ` 1r UVN, Email:
ARCHITECT 1
ENGINEER
Name: Regisration #:
Address: City.
Starte: Zip: Phone:
Contact Person: Email:
Licensed plumber installing
new sewer /water service: 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.
Aug 25 11 02:56p Bruce Nelson Plumbing & H
4 0 11 ' City of Etall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675-5694
Tenant Name:
Applicant's Printed Name
Former Tenant
Applicant's Signature
6517312804 p.10
For O rise � � // / �
Perrnit k f 0 V 6 / �`
Permit Fee: V `'' "
Date Received:
Staff:
P i u m ). R
1 2011 COMMERCI L PER MIT APPLICATION tr
Date Da ` I t Site Address: J �' VU k 1) 15 t t;, (v 0 C`
\fkQ.. � - 1 4 \, (Tenant is: New 1 !/Existing) Suite it:
Use BLUE or BLACK Ink
0
CALL BEFORE YOU DIG. Call Gopher State One Cali at (651) 454-0002 for protection .against underground utility damage.
Call 48 hours before you intend to dig to reoeive locates of underground utilities. www.000herstateonecall.orq
I hereby acknowedge that this information is complete and accurate; that the work wit 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
errnit; that the work will be in accordance with the approved plan in the - ° of wo req Iles a review a(I approval of plans.
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