3415 Surrey Heights DrPROPERTY
OWNER
. I 5 -C C�lJ` 1 c(52 • 2"/ 2 . cat7S
Name: ,D '1U Phone: hone:
CONTRACTOR
q - f�
Name: A it/— %/ G[J License lit �- l r t J
Address: fl Al / y � n/� C ,� ( C / /+
/ t/ 2 " St Cit fr 1 J State: !�' V Zip: � "7 /- l 2–
Phone:( 522_' O- 1 Email:
TYPE OF
WORK
New Replacement Repair 4_, Rebuild Modify Space _ Work in R.O.W.
Description of work: – Ci IS V�Z
PERMIT TYPE
COMMERCIAL New Construction Modify Space
_ —
Irrigation System (_ yes / _ no) (___ RPZ / _ PVB)
• Rain sensors required on irrigation systems
• Avg. GPM (2' turbo required unless smaller size allowed by Public Works)
Meters Call (651) 675 -5646 to verity that tests passed prior to oickino up meter.
_
Domestic: Size & Type Fire: 1
Avg. GPM High demand devices? Yes No Flushometers Yes _No
COMMERCIAL FEES: / ' y�
$55.00 Minimum (includes State Surcharge) OR Contract Value S � ✓ • x 1%
Required
- If the Permit Fee is less
= $ �0. 00 Permit Fee
on ALL new buildings and boulevard irrigation systems 4 S Radio Meter Read
than $10,010, the surcharge is 55.00 Sj . 0 Meter(s)
- If the Permit Fee is >
510,010, the surcharge increases by 5.50 for each 51.000 Permit Fee State Surcharge
Permit Fee requires a 55.50 surcharge)
(i. e. a 510.010 - 5 11.000
Following fees apply
Contact the City's Engineering
when installing a new lawn irrigation system S Water Permit
Department. (651) 675 -5646. for required fee amounts. S Treatment Plant
S Water Supply & Storage
5 State Surcharge
= $ p 6 ? TOTAL. FEE
City of Et all p ct
3830 Pilot Knob Road /w 1
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
x
App1fcants }'Tinted Name
x
2011 COMMERCIAL PLUMBING PERMIT APPLICATION
Date: I0 •*, \ Site Ad ress: 3/1 5 5A iV K
Tenant: 5L,LII7KZ'i (.J(Jjt7 Suite #:
Applic Vs Signature
Use BLUE or BLACK Ink
For Office Use
Permit #:
Permit Fee:
Date Received:
Staff:
CALL BEFORE YOU DIG. Call Gopher State One Call at (651)454 -0002 for protection against underground utility damage. Cal! 48 hours before you
intend to dig to receive locates of underground utilities. www.gaoherstateonecall.orq
I hereby acknowledge that this information is complete and accurate; that the work will be in nformance with the ordinances and codes of the City of
Eagan: that 1 understand this is not a permit, but only an application for a permit. and war is not to start without a permit: that the work will be in
accord with the approved plan in the case of work which requires a review and approval ans.
FOR OFFICE USE Approved By: Date:
Required Inspections: _ Under Ground Rough - In Air Test Gas Test _Final PRV Required: _ Yes — No
Page 1 of 3
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