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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