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2120 Water Lilly Lane al p~►o2v~ , o~.lv~~t' i ~'~26, 02►o~lJ, Use BLUE or BLACK Ink a ► 3n~ 30 W444`4- L'I Yl~ I For Office Use------- I 2 q I I ~ City of Eayn ( Permit Fee: (v39 •a5 I ' 3630 Pilot Knob Road I I 01 / Eagan MN 55122 1 Date Received: Phone: (651) 675-5675 1 Fax: (651) 675-5694 I Staff: I 2 t-----------------I BUILDING 2013 COMMERCIAL PERMIT APPLICATION Date: Site Address: A u C f I t t Tenant Name: g t ant is: New / Existing) Suite Former Tenant: Name: Phone: Property Owner Address /City /Zip: Applicant is: Owner Contractor Type of Work Description of work: r l~~< Construction Cost: < <..,.TT~ .,-e....o,.aw.. .nom .e .a,.-.., Name: License °r . Contractor Address - City: - State: Zip: Phone: Contact: Email: - i° P- Name: Registration rchitectlEngineer Address: City: State: Zip: Phone: Contact Person: Email: Licensed plumber installing new sewer/water service: Phone NOTE. Plans and supporting documents That you subma 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. 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 jeview and approval of plans. Applicant's Printed Name Ap`Dlidant's Signature Page 1 of 3