3579 Blue Jay Way 202 ::::
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EAGAN
Permit Fee:
Staff:
Payment Recvd: _Yes No
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-5694 Plans: Electronic Paper
Plan Submittal: eplansi citvofeaban.com L
2018 COMMERCIAL BUILDING PERMIT APPLICATION
Date:/O / . 1t"16 Site Address: 5 7? y/ 1 JY (ii A- �6 a
Tenant Name: A im Y 6 U 1,7 i (Tenant is: I., New/ (\---'Existing) Suite#: a r
Former Tenant:
Name: Vf ! lQ (J it J � Phone:
i
Property Owner 14
P y Address/City/Zip: 7 �G L S f} V (t 1 0 1
Applicant is: Owner Contractor
1 D63 Type Of Work t Description of work: c ari< r t ( L �'• 6 I
i
I Construction Cost: C)O
I Name: (9PY1. e. t( i. a O C Or icense#: C i ?/ o
Address: 5
i Contractor
3S6 S ztYy1 (V4" City: i 0 I 4
State: Zip: s'- 5 7 2 Phone:
C(4/ / ?7 r 3
I Contact: 1 Yl/A Email:
Name: Registration#:
1
Architect/Engineer IAddress: City:
0 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
I classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets.
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.citvofeagan.com/subscribe.
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.aooherstateonecall.orq
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, an. . is not to start without a permit; that the work wil ie in
accordance with the approved plan in the case of work which requires a review and alp. oval o .lans.
IIIP
x >4 YY) '' 2-ep 5iih (Ad,ii:„ (
Applicant's Printed Name Applica, 's Signature