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2202 Water Lilly Lane Use BLUE or BLACK Ink r For Office Use Permit 113 to9LA Y Cat of EaRan Cp50 . Sa I Permit Fee: 3830 Pilot Knob Road I ~ Eagan MN 55122 I Date Received: -IJ 3 I Phone: (651) 675-5675 I I ~9. Fax: (651) 675-5694 j Staff: l5_ C> I L-----------------I 2013 131"ILDING PERMIT APPLICATION Date." Site Address: Tenant Name: T errant is: New / Existing) Suite Former Tenant: Name: Phone: Property Owner Address / City / Zip: Applicant is: Owner Contractor Type Work Description of work. - - r Construction Cost v Name: License Address: City: State: Zip: Phone: Contact: Email: Name: Registration Ar hitect6E gi eer Address: City: 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 he public information. Portions o® the information may be classified as non-public if you provide specific reasons that would permit the City to conclude Jiat then 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.orq 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 wok which requires aveview and approval of plans. U x,t x~~ m Applicant's Printed Name Afsp,rant's Signature Page 1 of 3