1885 Ruby Ct N
v ' J~ ~5 ► loll, t -7 1 Use BLUE or BLACK Ink
I For Office Use
-y,
Permit #1159( City Eq,
O1 n
I I
I Perm
it Fee: J~~ • Pl~~ I
3830 Pilot Knob Road I
Eagan MN 55122 I I
Phone: (651) 675-5675 i Date Received:
Fax: (651) 675-5694 j Staff: j
L-----------------I
5
2013 COMMERCIAL BUILPING PERMIT APPLICATION
Date: 1 1771 I'S Site Address: ( ~ I _ kA\ ~f ~p~Iln,
v~
KM
Tenant Name: ~,~F~th t10~n5 ~.i►\~c.S 04 (Pprac4 kom%(Tenant is: -New/ X Existing) Suite
Former Tenant:
Name:D Mt.~ c.«,nohS V►~►as onA %ogCcIan I".S Phone: 1533- w 3 A- 81 7 9
Property Owner Address / City/Zip: P-0 Do% S N>3e.tw\jvv-~ ~ 111 DSO 68
Applicant is: Owner Contractor
Description of work ' Gr"f O~ - ~oyt A~ C\~rat, S . nh Ct ~A~ C-
Type of Work
Construction Cost: 3I , 7,51 . S /
Name: o ~ Lov\.s}('%X-~►o License t )t- .Cap 1 e1
Contractor i Address: 1~ (e~om~t avL City: ~OSL t"~UJh
State: mk) Zip: 575'0(69 Phone: :Z k x - Ll 9 (05
Contact: Ll(N+ } Email: LGol 'o~ Gall
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 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 review and approval of plans.
x o
x
Applicant's Printed N "e Applicant's Signature
Page 1 of 3