2210 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
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