3910 Cedarvale Dr
For Office Use
Permit G
City of Ea V
Permit Fee: I
3830 Pilot Knob Road
Eagan NIN 55122 Date Received:
Phone: (651) 675-5675 Fax: (651) 675-5644 staff:
------J
2009 COMMERCIAL BUILDING PERMIT APPLICATION
-09 3 7JJ C Qa~ar'1/a /e or,
Date: site Address•
Tenant Name: (Tenant is: New / Existing) Suite
Former Tenant:
PROPERTY OWNER Name: Derko f i COv4 ty CD 4 Phone: 6 5 6 7%5-- YY 67
Address / City / Zip: 12- 219 7'O ,17 C en 7tf'-e Drive
Applicant is: Owner KContractor
TYPE OF WORK Description of work: 49y: Uhl P e,n d
Construction Cost:
CONTRACTOR Name: W _eAe,1A Rvset EKC4Va/, 9 ,the,, License
Address: /J65e Co yn f y iQ o4rd Z//
City: c O l od State: Al /V zip: 5S 3 2 2
Phone: 1?5'2 - '/6'- Z Z. 3 / Contact Person: OO'
ARCHITECT i Name: M C I i"554 7q/),4 O /'rr Registration
ENGINEER
Address:
City: State: Zip:
Phone: Contact Person:
Licensed plumber installing new sewor/water service: Phone
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information maybe classified as non-public if you provide specific reasons that would permit the City to
conclude that the are trade secrets.
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 fora 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 Don W %eIf egiha& rem x oo's'^' kLy.-4 J za . _
Applicant's Printed Name Applicant's Signature
Page 1 of 3
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For Office Use
City o Ea ~!1 Permt i Permit Fee:
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone: (651) 675-5675
Fax: (651) 675-5694 I Staff:
2009 SEWER AND WATER REPAIR / DISCONNECT PERMIT
Date: Fee: $50.50
_ City Sewer City Water Repair Disconnect
Description Of Work: ! 1 tt'. 1 E r
Street Address for Proposed Work ! V [ `i &'t k Vr
OWNER Name: 0 `I 1 L 1 Phone:
Address / City / Zip:
Applicant is: Owner Contractor
Licensed Pipelayer* Master Plumber Property Owner
Name: '10h i ~Cl~ lil ~Pt ~E'( Phone: l_ - _2 7 2
Address/ City /Zip: (')ruaL V2 • ( L) I nna 6, 14, 4'7
Pipelayer Training Certification Card 0'S 7 , or Master Plumber License
I acknowledge that the information is complete and accurate and that the work will be in conformance with the ordinances and codes
of the City of Eagan and the State of MN Statutes. I understand this is not a permit, but only an application for a permit, and work is
not to start without a permit.
5b 4 Ilti;c~ e1 k$L s e r ~ Applicant (Print Name) Applicant's Signature
C$TY Or EAGAN WATER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.: -
Eagan, MN 55122 DATE: —
Zoning: — — No. of Units:
Owner :. /
Address: y / A�- n->
Site Address: --
—
Plumber: —
Meter No.• Connection Charge:
Size: — Account Deposit:
Reader No.: Permit Fee:
agree to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges: -
Total:
By
Date of Insp.• / ¢' Insp.:
CITY OF "EAGAN SEWER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: _ No. of Units: —_
Owner:
Address:
Site Address:
Plumber: — -- - - - - -- - - -- —
I agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit: — —
Permit Fee:
Surcharge:
By - - Misc. Charges:
Date of Insp.: — Total:
Insp.: Date Paid: