Loading...
1870 Sapphire Pt 1 N62 , 156 4 rll~ `e>O (p 1 `btaS, 116-701 Use BLUE or BLACK Ink r - - - - - - - - - - - - - - - - - I For Office Use f I p f Ea ~11 I Permit 5_[ I City of n I t ~D I Permit Fee: 3830 Pilot Knob Road I Eagan MN 55122 I I Phone: (651) 675-5675 1 Date Received: Fax: (651) 675-5694 Staff: i-----------------112 2013 COMMERCIAL BUILDING PERMIT APPLICATION g tc.~1► Date: 1 d~7 VS Site Address: t-~ 1 r Tenant Name: o l (,tatlc^ kom$(Tenant is: New / >1 Existing) Suite Former Tenant: ~ Name: D;mfN (-on5\6w5 X VMo►S wn~ gaCdc,n Iror•c5 Phone: 9Z) 43a- 8979 Property Owner Address / i City / Zip: r. ©X J X105 G hojv% N~ M 55-0 (a$ Applicant is: Owner Contractor Description of work 1 Ac- Orr- Govt GK l'l~rat S . nh Ct,OA~ C- Type of Work Construction Cost: H5, ~o Name: O y cov0(%x i d License AJ 1 01 Contractor Address: ~kojv\At c- a%JL City: IOsL ("~o~h State: M k) Zip: 175-069 Phone: -'-NA0C-,G ~J• I ' ;Z Ll 9 6 Contact: L't") i Email: ~cljt v ~-ek~ tC: od'S G=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 the 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 36 Applicant's Printed N e Applicant's Signature Page 1 of 3