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2248 Water Lilly Lane a~a= aa4~, aa14 b L~ use BLUE or BLACK Ink a~~ V /y~~ = P'o1Sn aa5 ~ W oZ / I For Office Use ' 113 Ga l Permit n I !!1, CR of Eap Y I Permit Fee: 25 3830 Pilot Knob Road I Eagan MN 55122 I I rJ I I Date Received: Phone: (651) 675-5675 Pax: (651) 675-5694 I Staff: I - L-----------------I 2013 COMMERCIAL BUILDING IT APPLICATION Date: 13 Site Address: ~I- Tenant Name: (Tenant is: New / Existing) Suite Former Tenant: Name: Phone: Property Owner Address ! City / Zip: Applicant is: Owner Contractor Description of woriz : l Type of Work - ~ Construction Cost: Name:. License Address: _ s `r a City: Contractor State: _ Zip: P Phone:, , Contact: Email: Blame: Registration rchitecJE rer Address: City: State: Zip: Phone: Contact Person: Email Licensed plumber installing new sewer/water service: Phone DOTE: 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 hermit the City to conclude that their are trade secrets. 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.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~teview and approval of plans. t z /01 F Applicant's Printed Name Appl'icant's Signature Page 1 of 3 Page 'I or .5 Applicant's Printed Name