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
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" I Permit , I LS Oi
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- Coly of Eap
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I Permit Fee: ~ Pug • ~ ~ ~ /
3830 Pilot Knob Road I I
Eagan VIN 55122 j Date Received: 5
Phone: (651) 675-5675 I I oZ !
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Fax: (651) 675-5694 j Staff: U~~ I
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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
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