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1903 Ruby Ct N t?m5 ' ~~1 I 1~ O' Use BLUE or BLACK Ink 'R." N - - - - - - - - - - - - - - - - ; ' I For Office Use ` Permit 15q City of Ea a~ I Permit Fee: O 3830 Pilot Knob Road I I Eagan MN 55122 I t Zk I 1-;~ Phone: (651) 675-5675 i Date Received: 0 Fax: (651) 675-5694 j Staff:. I t-----------------I 2013 COMMERCIAL BUILDING PERMIT APPLICATION Date: '1 d~7 ~3 Site Address: --1 Tenant Name: pmky, Ccx t\ ~ _i \\&S es4,I (Pa,dt4 kortS(Tenant is: New / > Existing) Suite Former Tenant: QQ Name:D ~t Gonv\pnS .l \j%kk&S wnl choar k4,~ IrwrwS Phone: _ l ob- y 3 a' 8~7 9 Property Owner Address/ City/ Zip: v ~ t JrJ~Ob$ - Y.h elk 5 ROSet~o~►n Applicant is: Owner Contractor Description of work I Gcoc- O ~c- ~Ac- Govt' AK ~ K nor. 5 . ^h Ct O w. C` Type of Work Construction Cost: O r 0'"1~ $S Name: O ~ Cph . (_1 1 i o License \J ~a2 1 t a1 Contractor Address: ~kojv\At 'C' a`uC- City: IO~jL i"`ea~~1 ~ State: Zip: '750(61? Phone: G Jr I - 21.1- `I 9 Go Ur Contact: Email: ~~~t ~d ~e~ftC~ od'S. C~or1 -Name: Registration Architect/Engineer Address: City: State: Zip: Phone: Contact Person: Email: Licensed plumber installing new sewer/water service: Phone 11 11 11 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 b\e-in accordance with the approved plan in the case of work which requires a review and approval of plans. x Lces)_ I O 'T x ~6L Applicant's Printed N We Applicants Signature Page 1 of 3