985 120th St WTenant: J J T T4 +-a y 1 — 1 /7t)'1 7/71/.9 f 11E- " 'Suite #:
PROPERTY
OWNER
�
Name; rt,r 1 r, tau Phone:.
CONTRACTOR
.
Name: A A U Mk I n Licen #: (pfl 1 -.
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Address: -`APn is city: 1 , State Zip 661 .
ra
Phone: v k?\AC) Email; CI- L - i+n 6`
TYPE OF
WORK
_ New 4 Replacement Repair _ Rebuild _ Modify Space Work in R.O.W.
Description of work: G t! f.� C7 ,,�,� t /� r
p (1 s 't? � /
PERMIT TYPE
COMMERCIAL
New Construction )C Modify Space
Irrigation System ( yes i_ no) ( RPZ 1 PVB)
•
• Rain sensors required on irrigation systems
' Avg. GPM (2" turbo required unless smaller size allowed by Public Works)
Meters Call (651) 675 -5846 to verity That tests passed prior to picking up mete[.
Domestic: Size & Type Fire: 1
Avg. GPM _ High demand devices? _Yes No Flushometsrs _Yes No
COMMERCIAL FEES:
$55,00 )Minimum (includes Slate Surcharge) OR Contract Value s Zr 1 i f C x 1%
Required
- If the Permit Fee is less
.
e $ Z. 1 . Ka Permit Fee
on ALL new . buildings and boulevard Irrigation systems .3 =; — Radio Meier Read
than $10,010, the surcharge Is 55.00 .$ Meter(5)
- If the Permit fes is 510,510.
the surcharge Increases by $.60 for each 51,000 Permit Fee
Permit Fee requires a 55.50 surcharge) = $ State Surcharge
(i.e. a $10,010. 511,000
Following fees apply
Call the City's Engineering
when installing a new fawn irrigation system. 5 Water Permit
Department, (651) 675 -5545, for required Pee amounts,
$ Treatment Plant
$ Water Supply & Storage
$ Stele Surcharge
TOTAL FEES $ 24.Y • 4,5 66
Jan, 25. 2011 12:22PM Champion Plumbing 1 - 651 - 365 - 1332
• FOR.9EFI.CE USE -
C!ty :f 11Ill
3830 Pilot Knob Road
Eagan MN 65122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
2011 COMMERCIAL PLUMBING PERMIT APPLICATION
Date: 1 1 2 Slte Address: "'yr - I bc1 ,ffireet
Applicant's Printed Name'
•
x ‘," We‹.,-‘F
Applicant's Signature
No. 2481 P. 7
Use BLUE or SLACK Ink
For Circa s " ]
Perrhil #; 1 `/ q&
Permit Fee: •06
Date Received:
Staff;
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.ciopherstateonecall.ppq
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 re ul s a review and approval or plans.
Approved By: - - _ . .. :pate: • • •
.
ul
Required [rispections:. Under• Ground • :Rough Final PR1! Re -In ' -Air Test Test Rai :piked: : Yes ^No
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