2234 White Water Way
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Use 8-LUE oi- BLACK Ink
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Permit I
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3830 Pilot Knob Road Permit Fee: I 776 (o 5L- 1
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Eagan MN 55122
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Phone: (651) 675-5675 1 Date Received: C1 I V/
Pax: (651) 675-5694 j Staff: 5(12;1
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t-----------------I -
2013 COMMERCIAL BUILDING IT APPLICATION
Date: Site Address: Z23 Z_
i
Tenant game: (Tenant is: New / Existing) Suite
Former Tenant:
Name: Phone:
Property Owner Address / City / Zip:
Applicant is: Owner Contractor
Description of work: i
Type of Work - `
Construction Cost:
7 -V Name: _ License
Address City:=
CO
State: Phone:
Contact: _ Email
Name: Registration
Architect/Engineer Address: City:
State: Zip: Phone:
Contact Person: Email:
Licensed plumber installing new sewer/water service: Phone
NOTE: plans and supporting documents that yore suhrrait are considered to be public inforâ–ºrration, portions of
the information may he 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 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 requires a,review and approval of plans.
01
Applicant's Printed Name App ant's Sig-iiature
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