3937 Valley View Dr SPROPERTY OWNER
Name: le _ /II 1 As _ Phone: E � ' I
_
' n
Address !City 1 Zip. '\ ' . .1 G1 -1 \ Pa , T" GL- (� t } 63 62
Applicant is: _ Owner Contractor
TYPE OF WORK
Description of work: L) L NC )--1 \j
Const-uction Cost
CONTRACTOR
^� J
Nar &KO Q _ 1 � (Cl
License#: Oak
Address: 1 � •
Cite kCU
State Zip: 5 \ `�� Phone: W L/..-
` t'"71— `� (} `�,5�
\
Contact . ) cY ; Email:
ARCHITECT t
ENGINEER
dame: Registration #:
Address City.
State: 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 02:59p Bruce Nelson Plumbing & H
4 CityofEagaii
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
`
2011 COMMERCIAL S D11 \ rPERMIT APPLICATION
Date ' I 1 t Site Address:3�3f \1CX\u—j J -t.. U C•
m `•�IJ �
Tenant Nae: Y �;k ,1J1� Q61{\�[ c) OS
hereby acknowledge that
codes of the City of Eagan;
permit; that the work will be
Applicant's Printed Name
nant is: New 1 k Existing) Suite #:
Former Tenant
p. licant's Signature
6517312804
Use BLUE or BLACK Ink
For Office Use
Pernit #: /O(`) 763
Permit Fee:
Date Received:
Staff.
CALL BEFORE YOU DIG. CaII Gopher State One Cal at (651)454 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.aooherstateonecall.oro
p.18
this information is complete and accurate; that the work will be in conformance with the ordinances and
that I understand tnis is not a permit, but only an application for a permit, and work is not to start without a
in accordance with the approved plan in the s of work r '« . a review . d appr u of plans.
( r
111 Ad
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