2248 Water Lilly Lane
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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 -
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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
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Applicant's Printed Name