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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 -
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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
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