2130 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-------
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City of Eayn
( Permit Fee: (v39 •a5
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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
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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
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