1903 Ruby Ct N
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' ~~1 I 1~ O' Use BLUE or BLACK Ink
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' I For Office Use
` Permit 15q
City of Ea a~
I Permit Fee: O
3830 Pilot Knob Road I
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Eagan MN 55122 I
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Phone: (651) 675-5675 i Date Received: 0
Fax: (651) 675-5694 j Staff:. I
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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:
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- 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
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