2213 White Water Way
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Use BLUE or BLACK Ink
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I For Office Use 1
1
I Permit ✓ Sn~~ 1
ity of Eap
1
I Permit Fee:-5,9 . 0 0 1 /
3830 Pilot Knob Road I .V/
I
Eagan MN 55122 I
I Date Received: I
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 j Staff: 2 I
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013 BUILDING COMMERCIAL PERMIT APPLICATION
Date: "qVj Site Address: a!L 2 t i1 t
Tenant Name: (Tenant is: New / Existing) Suite
Former Tenant:
Name: Phone:
Property Owner Address /City /Zip:
Applicant is: Owner Contractor
y'i' v-f or Description of work: tom. L '
Construction Cost: :,7 ~ e
1 f
License
Name: .t
Contractor Address: - City:
f
State: Zip: Phone: _y a
Contact: - Email:
Blame: Registration
Arch itecdEngineer Address: City:
State: Zip: Phone:
Contact Person: Email:
Licensed plumber installing new sewer/water service: Phone
DOTE: 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 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 -eview and approval of plans.
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Applicant's Printed Name Ap'P ant's Sicanature
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