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2112 Water Lilly Lane a~oa , al 0A I -.;I-\() (0 , aln 8 2110 1211; Use BLUE or BLACK Ink 2 t 4,► t t S t~- Ll4 I For Office Use ' 11~5a Permit#: Y I ' 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 Page 1 of 3