1938 Sapphire Pt
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Use BLUE or BLACK Ink
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q,S i For Office Use
City of nano n Permit ~j' \ S I Permit Fee: • Coc) i
3830 Pilot Knob Road l 'S Qx I
Eagan MN 55122 I l
Phone: (651) 675-5675 i Date Received:
Fax: (651) 675-5694 j Staff: j
L-----------------I~
2013 COMMERCIAL BUILDING PERMIT APPLICATION
Date: ~ 27 Site Address:
Tenant Name: tS at'1 comow5 a1 ~ ~v
.i►1~u5 ol ~ar srl ~lor+t,S(Tenant is: -New/ Existing) Suite
Former Tenant:
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Name: LoC1~10wS V~~~aS ^4 %0,rt <4, "s Phone: 95a1' 4 3.A- 81 7 7
Property Owner ~ M&I 5,6-0 (0
t ;Address /City /Zip: RO.SGh
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Applicant is: Owner Contractor
g Description of work l Gore O ~c- - Cc~y~ GK C1~rar 5 ,*a • ^h C-
Type of Work t 1
Construction Cost: 7 $ . 5 a
Name: O (_0VX ~ ('JAi o License \J 1 t of
Contractor Address: City:
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State: Mk Zip: '750(69 Phone: `c s ` ;Z I;L ` `1 9 5
Contact: L J I Email: ~G✓t ~d "1'e~~-`Ci o~'s. C~-c~r1
Name: Registration
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Architect/Engineer Address: City:
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g State. Zip: Phone:
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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
I 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.
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Applicant's Printed N e Applicant's Signature
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