2115 Cliff Dr
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Use BLUE or BLACK ink
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Mof Ea ~ Pemba:
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3830 Pilot Knob Road MN 55122
Phone: a 5.5675 ~ Date Received:
Fax: (661) 675-5694 j !
2013 COMMERCIAL BUILDING PERMIT APPLICATION
Daft:
&1241-2017 sft Address:
5 C t ,
Tenant Name: (Tenant Is: New I Existing) Smote S,
t r Foony eTenant:
Name. <fedar /
t ! t ~°1-f-trL c del `lone: - S~- 1C`
Property Owner Address i City 1 Zip: Z Z
Applicant is., Owner X Contractor
Type of Work Description of work: _ 1 e-ar 04 d~~iY'+oy Stites ~~J g- test
Construction Cost: 4 l ? SO
Name: _ 1 r! a 0e r 1 ~Jeo.4s i ru clo.A 4 .~lJ S 5" 7
Contractor Address: 11 ZZ J e t ( r.~ City: f vJe r
State: 10W Zip: 53J01 Phone: _ oo/2-
F-~tttilr':~ u~S klic{ ®n~i•~e. GdM
ae Contact: 4,00107 Emil: kedln
Name: Registration
Architect/Engineer Address: City:
State: Zip: Phone:
Contact Person: Email:
Licensed pknnber installing M sewer/meter service: Phone
NOTE: Plans and supporting documents that YOU submit are considered to be pubbc information. Portions of
the information may be ciassiffed as non public if you provide specific reasons would permit the City to
conclude that th are trade secrets.
CALL BEFORE )LOU DIG. Call Gopher State One Call at (651) 454.0003 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecalt.oro
1 hereby ac JxWedge that this information is compere and accurate; that the work will be in conformance with the ordinances and
codes of the City of Eagan; that I un demtand this is not a permit, but only an application for a permit, and words is not to start without a
permits that the words will be in accordance with the approved plan in the case of work which requires a review and approval of plans.
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ApplicanCs Printed Name A nah"
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