1854 Sapphire Pt
Use BLUE - BLACK Ink
i! ZJ I I For Office Use
Permit ✓ -4
City of Ea~d~
el I Permit Fee: (02.13. 0 10 I
3830 Pilot Knob Road I
Eagan MN 55122 I I
Phone: (651) 675-5675 i Date eive
Rec~,,d:
Fax: (651) 675-5694 j Staff: _0 V j
t-----------------1~4
2013 COMMERCIAL BUILDING PERMIT APPLICATION g U-"I tS
Date: 1 17711 3 Site Address: r Fr
Tenant Name: I-%q`4M (,pnnph5 kom',jenant is: New / > Existing) Suite M
Former Tenant:
Name: ~N ~oe~tlo..s V►~~a5 nn~ gaCdcnln .5 Phone: 6aA- 43a- 8179
Property Owner ROS
Address /City /Zip: DO~C .3 ehogvt~ ~ llJ 5 5 0 (o$
Applicant is: Owner Contractor
Type of Work Description of work: l ~,t" Or~ - ~ov~ ~ti Claror 5 a . ~h Ct tea' C
Construction Cost: 1 *~j 5 • 79
Name: O ~ Coy\ . ('%Xl i o License tJ .C a~ 1 t a1
Contractor Address: ~ touv\At lc- City: q 105 M0jV%
State: Zip: 5750(69 Phone: 2 t +1 ' `f q 40 Contact: LICIJ Email: ~~v! Nd +e~~-tCa od'S. CsoP1
Name: Registration
Architect/Engineer Address: City:
State: Zip: Phone:
Contact Person: Email
Licensed plumber installing new sewer/water service: Phone M
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 e Applicant's Signature
Page 1 of 3