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Permit Fee: I
3830 Pilot Knob Road 1 1
Eagan MN 55122 I I
1 Date Received: I
Phone: (651) 675-5675 1 I
Fax: (651) 675-5694 1
1 Staff: ~h
1-----------------1 Ib
2013 COMMERCIAL BUILDING PERMIT APPLICATION 1a- U_j4'%k5
Date: Site Address: ~'~'t/ 1 i(lq p & -TZZ-122 3G
Tenant Name: V%~ ktK (4oMl~n5 1A&S V..4 ~ar~e1 kom$(Tenant is: New/ Existing) Suite
Former Tenant: r
Name: D~ t!~ ftns X V k11wS ^^A ! 1O T % Efts Phone: Q53A- 4 3;L- 81 7 9
Property Owner Address / City / Zip: _p.0 (jpk J 63etnow%Ir MAJ 55-0 (o I?
Applicant is: Owner Contractor
Type of Work Description of work 0i c_ 04-1c- Cpy{ ~iK n+r~ S . nh Ct a~ Crr
Construction Cost: b J ~ 3• i o
. Name: O T cove . ('%xiZ o License 1J t- .C2 1 t a
Contractor l Address 14,~p.t L koov\A-e c, a%lL City: i I~SL I"~U~~ T
State: Zip: ';5_0 (69 Phone: 211-c. S- I ' 2 9 (0 Jr
Contact: h{"j+ Email: ~G~t ~eJL~'tCi cd'S. Go,(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 x
Applicant's Printed N .We Applicant's Signature
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