Loading...
4129 Ruby Lane 1°I toy t l ci (e (a , late tcrl0 Rwloi~ CA N la3 A k t,51 A ► ~)"j t 41 Rq g Ili' 1S~NW Use BLUE or BLACK Ink I For Office Use n r~ ~ 115gsS I City of EaK an Permit I F ~ 4~ I 3830 Pilot Knob Road Permit Fee: i 1 Eagan MN 55122 1 Phone: (651) 675-5675 1 Date Received: Ind k 1113, ~ Fax: (651) 675-5694 1 Staff: n^f) i-----------------1 2013 COMMERCIAL BUILDING PERMIT APPLICATION (1o Abel I°Il~il ~ Date: C~1 12-7/ t3 Site Address: G~(OJ' 4 _ ~1Z31~rzS~ y►zilyl~g ~J~ t~4~O~{ G`_ V Tenant Name: Q~ F~th (QMft5 komtajenant is: New / X, Existing) Suite Former Tenant: Q Name:D 4.0m\oAs a, SAW-1 OtAl %!?Kr n I,MS Phone: 4 3;L- 81 7 9 Property Owner Address/ City /zip: RD Do)( 5 C1C3eh0Jv4 MAI 5'S b$ Applicant is: Owner Contractor Type of Work Description of work ► Cc~t' d ic~ - Coy~ GK C1„nit 5 a . ~h Ct C- ~y Construction Cost: 5 S 1 b 3 3 1 Name: O " C ov\.~ (-%xC -i a License lJ 22,11-1:L Address: IL L IL C `ojv\dt omic - City: I05L MOJvl T' i Contractor 4 State: Zip: T50(69 Phone: GPI " 2 1(.5 Contact: Email: ~Lut ~d ~e~~tC~ 0~5. Ca•o~'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.goi)herstateonecall.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 LI~, I x IJ~a I o L Applicant's Printed N We Applicant's Signature Page 1 of 3