2216 Water Lilly Lane
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Use BLUE or BLACK Ink
I For Office Use
I 1 I I cely of Eap Permit 1 co l0
I I
I Permit Fee:
3830 Pilot Knob Road I I
Eagan MN 55122 j Date Received: 5
I
Phone: (651) 675-5675
Fax: (651) 675-5694 I Staff: I
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2013 COMMERCIAL BUILDING PERMIT APPLICATION
Date: - Site Address:
Tenant is: New / Existin Suite
Tenant Name: (g)
Former Tenant:
Name: Phone:
Property Owner Address /City /Zip:
Applicant is: Owner Contractor
Description of work:
Type of Work
a
Construction Cost: 3Z4 j d,
Name: License
Address: - - City:
,tor
State: Zip: Phone:
Contact: Email:
Name: Registration
ArchitectfEngineer 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 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 Gall 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;.,eview and approval of plans.
r
a € x r -
Applicant's Printed .',lame Ap ant's Signature
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