2199 Rocky Rapids Way
Use BLUE or LACK lark
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For Office Use
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City EaRan Permit
I PermitFee• . ~~•5
3830 Pilot Knob Road I d i/
Eagan MN 55122 /
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Phone: (651) 675-5675 I Date Receiv~ed: 91J' I
Fax: (651) 675-5694 I E i
I Staff: I
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2013 COMMERCIAL BUILDING IT APPLICATION
Date: tt Site Address: 1 _
Tenant Name: &(enant is: New / Existing) Suite
Former "tenant:
Name: Phone:
Property Owner Address /City /Zip:
Applicant is: Owner Contractor
Type O~ 1'k Description of work: Zile, Construction Cost, -
- -
"L Jr
Name: g_ License
Address:
Contractor - -----=City:
State: Zip: ; Phone:
Contact: Email
Nllame: 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. Fortion.: or
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.gopherstateonecail.orq
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 eview and approval of plans.
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Applicant's Printed Name Ap cant's Si nature
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