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4198 Running Brook Rd 41 VA r 91 &6 ,,4 Vb& A V10 Use 3LIalE or BLACK Ink 41cl21 'Im4i .4 ~UlV1V11 i I For Office Use I I " I Permit , I LS Oi I I - Coly of Eap I Pug I I Permit Fee: ~ Pug • ~ ~ ~ / 3830 Pilot Knob Road I I Eagan VIN 55122 j Date Received: 5 Phone: (651) 675-5675 I I oZ ! c~ I Fax: (651) 675-5694 j Staff: U~~ I t-----------------I 013 COMMERCIAL BUILDING PERMIT LI i H Date: Site address:t qb I Tenant Name: (Tenant is: New / Existing) Suite Former Tenant: E Name: Phone: Property Owner Address / City / Zip: Applicant is: Owner Contractor i~ g- Type of OL Description of work: Re- Construction Cost: Name: License ;tor Address: -=-City: --'C. 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 thEt~ they are trade secrets. BALL 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.gol)herstateonecall.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 rewires a xeview and approval of plans. Applicant's Printed Name Ap t cant's SicU. nature Page 1 of 3