Loading...
4187 Running Brook Rd 4 1 4Vb 3, ,,1tSS7 I A 1 2~1 Use BLUE oi- BLACK Ink Qp~ I a l ~ V - 1 ( ~ ~ L~ ~ ~ `"1 ~ -15 ~ t 1 I "~J or Office Use I I Permit It aka I Permit Fee: _bq~. .a5 I / 3830 Pilot Knob Road I I ✓ Eagan MN 55122 j Date Received: ' I Phone: (651) 675-5675 I Fax: (651) 675-5694 j Staff: ~ I L-----------------I 2013 COMMERCIAL BUILDING PERMIT APPLICATION Date: j Site Address: qI13(,1fl003A96;4V?7441V1 4191 l 1414? Bre Name: f errant is: New / Existing) Suite Former Tenant: Name: Phone: Property Owner Address / City / Zip: Applicant is: Owner Contractor _ w.. Description of work: i__ Type of cork u ~ Construction Cost: 1,7 ~303 i Name: License _ Address: - - - City: - - State: Phone: , Contact: Email Narne: Registration Address: City: Arch €teot/Engineer State: Zip: Phone: Contact Person: Email: Licensed plumber installing new sewer/water service: Phone # NOTE: Mans and supporting documents that you submit are considered to be public information. Portions o the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that they are trarle secrets. CALL BEFORE YOU DICE. 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. Applicants Printed Name Apply ant's Signature Page 1 of 3