2231 Creekside Ct
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For Office Use
Permit ~ j~A
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3830 Pilot Knob Road I Permit Fee:
Eagan MN 55122 I I
Phone: (651) 675-5675 1 Date Received: rJ I
Fax: (651) 675-5694
I Staff:
L-----------------I
2013 COMMERCIAL BUILDING PERMIT APPLICATION
Date: Site Address,' .cam- 6reek3iSe C_~
Tenant Name: (Tenant is: New / Existing) Suite M
Former Tenant::
Name: Phone:
Property Owner Address /City /Zip:
Applicant is: Owner Contractor
Type of Work Description of work: f! I ; r- o w
Construction Cost-
a
Name:
- J License J
Contractor Address: - __-City.
State: Phone:
Contact: Email - -
Name: Registration
Architect/Engineer 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.
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 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 feview and approval of plans.
•.®.am 3'~ e'er X
Applicant's Printed Name Ap`~tl'canfs Si nature
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