4189 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