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L
Permit
City of Ea I Permit Fee:
3830 Pilot Knob Road i I
Eagan MN 55122 i
I Date Received: I
Phone: (651) 675-5675 1
Fax: (651) 675-5694 j Staff:
i-----------------1
2014 COMMERCIAL BUILDING PERMIT APPLICATION
Date: Site Address: I `l )`?0 -7
Tenant Name: u~1 o a r (Tenant is: New / Existing) Suite
33 Former Tenant:
_ i Name: 3 /,49 . Phone: erZ 77 - `l
I
Property Owner Address / City / Zip: pl~~,/! 7~
i
E Applicant is: Owner Contractor
Type of Work Description of work:
I
Construction Cost:
Name: AlOi~ W e S 1 C 0 4/ eiY6 License
1
Contractor Address: _6 L 3 City: )NrIc- 6101;C
State: A dam Zip: 55 311 Phone:
Contact: Email:
j Name: Registration .4) If Architect/Engineer Address: City:
State: Zip: Phone:
i
tl
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. Portionof
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that the 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, ch requires a review and approval of plans.
x ~J r y;r>v
Applicant's Printed Name is nt's Signat
Page 1 of 3
•
Ay x�• S ;4.e,..._ `..yam I
For Office Use .,...-..n_?..10Permit#: J
r Permit Fee:
w• • ' r/r
,: I
... E A Staff:
mem�' �
y,SS SLya.$F.y,¢c O
�►'""`� 1
nt Recvd: ____Yes -_-_
�'+ Payme
122
-1810
PILOT KNOB ROAD I EAGAN,MN 55 75-5694
: 651 6 Paper
3830TDD:(651)454-6535 i FAX ( )
Ema(65il:
675-5675 I n Pians: Electronic �
Email b it i ( t----------------- I
r.,Aaan.com i
Plan Submittal: oIa �"'
20�8
COMMERCIAL PLUMBING PERMIT APPLICATION
plans with all commercial applications as well as an electronic set of thesubmittal.
0 Please submit two(2)sets of paperCD or flash drive
via email,
submitted Or _ ,
i .i / Site Address: e D Date: Suite#:
Tenant ��, _ e..�-
Ir
Property i /. .r�.�.o,f_ -hone: /' v
Owner Name: A •
Name: I, &. i1 *AL ' .. A I /'l9n O'aJ4s Agri-se#: r"
Contractor Address:
Li 1 5- T mA2 -tEy: 0 I State Zip: o 91I
6s- 1 • e Igo �� �� , �C , a•.o
Phone: l _ 7 as 5 7 Email:
--_— -t -- .. _�__...... Work in R.O.W.
—New Replacement Repair Rebuild Modify Space _
�^ e� �2
Type of Work `W0.St
Description of work:� �}
!-
COMMERCIAL New Construction •_Modify Space
M t
,_Irrigation System(_yes/_no)(,_RPZ 1 PVB)
{ . Rain sensors required on irrigation systems � 1
1
i Permit Type • • Avg.GPM (2"turbo required unless smaller size allowed by Public Works) {
Meters Call(651)675-5646 to verity that tests passed prior to Dickins up meter. t
Domestic:Size&Type Are: 1
__ Avg.GPM High demand dt-vices?..., Yes,_:No_.-.._.- _.__Flushometers_Yes_No {
i COMMERCIAL FEES Contract Value$ ' R0 0 x.01 `
j $60.00 Permit Fee Minimum =$ Permit Fee
$60.00 PVB/RPZ Permit(includes State Surcharge)
=$ �\ Surcharge
i' Surcharge=Contract Value x$0.0005 =$ �� - J V TOTAL FEE
If the project valuation is over$1 million,please call for Surcharge
Water Permit
Following fees apply when installing a new lawn irrigation system $ Water
ent tant
Contact the City's Engineering Department,(651)675-5646,for required fee amounts. $ Trn
$ Water Supply Storage
$ State Surcharge litt
I =$ TOTAL FEE ;
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.citvofeeoan.comisubacrlbe.
CALL BEFORE YOU DIG. Call Gopher State One Call at(661)464-0002 for protection against underground utt the Cityof Eagan; I understand this is not a
I hereby acknowledge the,this WonnNion Is complete and accurate;that the work will be in conformance with • , •-s and '" in tcase of thataI understand
requires a review
permit,but only en application permit,and work is not to start a permit,that the work will be in Li
; Ore
and a al of plans.
/'
X nil )e ax ,ii. / ./ .1.-. t.e.A.,&.
Applicant's Printed Name Applican a Signature qFUR OFFICE USE Approved ByDate: f'Zq /�as Test / ---(-)
al PRV Required: Yes No
Required inspections; _Under Ground _Rough-In Air Test —G _. —
Meter Related Items: Meter Size Radio Read Manometer Staff:
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