3204 Borchert Lane
Use BLUE or BLACK Ink
r
For Office Use
Permit I Cc 1,
C)
City of Eap 1 00 I
Permit Fee:
3830 Pilot Knob Road I I
I
Eagan MN 55122. 1
11-3 1
Phone: (651) 675-5675 i Date Received:
Fax: (651) 675-5694 I I
I Staff: I
L------
r COMMERCIAL BUILDING PERMIT APPLIC ION DateSite Address: Z_/ 7
Tenant Name: (L" T'/ U F (Tenant is: New / Existing) Suite
Former Tenant:
Name: epe}"64,-j Phone: X 53-2 q
Property Owner
Address /City /Zip:. 7j a_e3o P^~+
~LU I kvUJ P-/2
Applicant is: Owner Contractor
Type of Work ! Description of work: SGJ11J5/~LTC/L Cy~J~Tf~ T LcJ~
Construction Cost: 00 62
Name: 5n? G License
:
Contractor 'Address: City:
State: Zip: Phone:
s
Contact: Email:
Name: ^V11 - Registration
Architect/Engineer Address: 200 S. E ~ .5 1.JCity: S~J U f+zj
~7
S_ Ci Z
State: 4-F-i--1--- Phone: 'S_0 0 'Z
Contact Person: Q S ail:
Licensed plumber installing new sewer/water service: Phone M
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.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org
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 appl' tion for a permit, and work is not to start without a
permit; that t e ork will be in accordance with the approved plan in the case of w r w ch quires a review and approval of plans.
x 4PW L 6 ~ x
Applicant's Printed Name Appli ant's Signature
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DO NOT WRITE BELOW THIS LINE
SUB TYPES
Foundation Public Facility _ Exterior Alteration-Apartments
(Commercial / Industrial _A_/ Accessory Building _ Exterior Alteration-Commercial
Apartments _ Greenhouse / Tent _ Exterior Alteration-Public Facility
Miscellaneous Antennae
WORK TYPES
New _ Interior Improvement Siding _ Demolish Building*
_ Addition _ Exterior Improvement Reroof Demolish Interior
Alteration Repair Windows Demolish Foundation
Replace _ Water Damage Fire Repair _ Retaining Wall
Salon Owner Change *Demolition of entire building - give PCA handout to applicant
DESCRIPTION
Valuation DO E+ Occupancy A ' 3 MCES System N
Plan Review - - Code Edition Z~fl SAC Units
(25%_ 100%- - Zoning City Water
Census Code Stories f Booster Pump
# of Units U Square Feet 3zo PRV
# of Buildings Length Fire Sprinklers
Type of Construction /3 Width
REQUIRED INSPECTIONS
Footings (New Building) Sheetrock
Footings (Deck) V' Final / C.O. Required
Footings (Addition) Final / No C.O. Required
Foundation Other:
Drain Tile Pool: -Footings -Air/Gas Tests -Final
_ Roof: -Decking -Insulation -Ice & Water -Final Siding: -Stucco Lath -Stone Lath -Brick
✓ Framing Windows
Fireplace: -Rough In -Air Test -Final Retaining Wall
Insulation Erosion Control
Meter Size:
f
r
Final C/O Inspection: Schedule Fire Marshal to be present: Yes No
Reviewed By: Building Inspector Reviewed By: , Planning
COMMERCIAL FEES L"4&x-
Base Fee dN Water Quality
Surcharge. Water Supply & Storage (WAC)
Plan Review 0. Storm Sewer Trunk
MCES SAC Sewer Trunk
City SAC Water Trunk
S&W Permit & Surcharge Street Lateral
Treatment Plant Street
Treatment Plant (Irrigation) Water Lateral
Park Dedication Other:
Trail Dedication
Water Quality TOTAL
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