2112 Water Lilly Lane
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I For Office Use
' 11~5a
Permit#:
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' C"l3a.75
I Permit Fee:
3830 Pilot Knob Road 1 c I
Eagan MN 55122 1 Date Received: J
Phone: (651) 675-5675 1 j
Fax: (651) 675-5694 j Staff: I
t-----------------1
2013 COMMERCIAL BUILDING PERMIT APPLICATION
Date: Site Address:
Tenant Name: (Tenant is: New / Existing) Suite
Former Tenant:
Name: Phone:
Property Owner Address /City /Zip:
Applicant is: Owner Contractor
Description of work: '
Type of Work
Construction Cost:
Name: License
Address: - _ City.
Cot
State: /-ip: Phone:
Contact:— Email:
Name: Registration
Address: City:
Arch itect/ ngineer
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 then are trade secrets _ . .._fn _
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 re uires aview and approval of plans.
X tr` x t
Applicant's Printed Name Ap cant's Signature
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