2247 Creekside Ct
j a~4~~ aaL1.S~ i -7~ ~----se BLUE or BLACK ink
For Office Use I
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Permit l1d~0 J I I
1~V o Eap
I Permit Fee: g 00
3830 Pilot Knob Road
Eagan MN 55122 I Date Received: rJ I
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I I 16
Staff:
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2013 COMMERCIAL BUILDING PERMIT APPLICATION
Date: 13 Site Address: s 5-laq-7 Q,41,1961
Tenant Name: (Tenant is: New / Existing) Suite
Former Tenant:
i
Name: Phone:
Property Owner Address /City /Zip:
Applicant is: Owner Contractor
- -
Type of Work Description of work:
Construction Cost: 71 Lea
Name: t_ License - -
Address: _ - T City
Contractor - - -
State: _ Zip: Phone:
Contact: " Email. z ;
Name: Registration
Arch itect/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 review and approval of plans.
x t i x t°w-
Applicant's Printed Name Ap`ttbant's Signature
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