2240 Water Lilly Lane
X30 ;Q-3, a, as 3~
Use BLUE or BLACK Ink
8 as 4o wow
t----------------
f I For Office Use
Permit City of EaV Permit Fee: i •
J I I
3830 Pilot Knob Road I Cj
Eagan MN 55122 I Date Received: a
Phone: (651) 675-5675 I I
I
Fax: (651) 675-5694 j Staff: I
1-----------------I
2013 COMMERCIAL BUILDING PERMIT APPLICATION
J ' f V Date: Site Address: 11~Xnl
Tenant Name: (Tenant is: New / Existing) Suite
Former Tenant: C
Phone:
Name:
Property Owner Address / City / Zip:
Applicant is: Owner Contractor
Type of Work Description of work: i i
Construction Cost: I
4 Names' C> - License
Address: City: = . _Contractor
State: j. r, - Zip - Phone: 'la-61 V~60 e/
_ P
Contact L E m ail:
s
Name: Registration
Address: City:
Architect/Engineer
a
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 that they are trade secrets. 4 .w,..
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.qopherstateonecall.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 re uires a view and approval of plans.
X. t x
Applicant's Printed Name Ap ant's Si nature
Page 1 of 3