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1955 Ruby Ct N ~otr~3, l°t 55, t`~~~ I°lS°I~ t q , tq ~3 Use BLUE or BLACK Ink 1~5 Mal, t°171 101 ~3, I0 I For Office Use l flQ r Ct N Permit I I City of Eq, I Permit Fee: 1 3830 Pilot Knob Road I 1 Eagan MN 55122 Phone: (651) 675-5675 i Date Received: Fax: (651) 675-5694 j Staff:? j L----------------- I 2013 COMMERCIAL BUILDING PERMIT APP ICA IT - !3~ gP, c Date: 1 1;L7 I3 Site Address: I~~3 S~~rtS~~~~sU \a~~~~~b ~`~4 t ~1 Ilg~g~ tg-►~1q-► ~tQ~S" J Tenant Name: ko t*Tenant is: New / Existing) Suite Former Tenant: Q Name: A~N -OC1t'10.►5 X Vktkos ok^l aVxc4, 4wr~tS Phone: 15aA- 4 3 a- 81 7 9 Property Owner c p Address/ City /Zip: P.b e7x J rio3e- hcwv% M AJ 5-5-0 b$ Applicant is: Owner _ Contractor Description of work I ,C- d ~c - ~,OC)T an C S C- Type of Work Construction Cost: 5_7 V%L. t k v Name: D ~ C.0v\.5~('\JrAi d License AJ 1 t o1 Contractor Address: [Lw_ r `OJAA-e lc- a%lL City: 11 lOrjL f"~n~h State: Mk) Zip: '75'0(Q Phone: J1r ;Z Ix `f 1 (10 Jr Contact: Email ~G~I k-Id + e~-tC o'r`J . G o1~1 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 T x Applicant's Printed N e Applicant's Signature Page 1 of 3