1680 Meadow View RdMeadowview Road
1;1/0
1`Jl 1J`l`I`!1?IT/ i
1670-1680 Meadowview Rd
This map is for reference use only.
This is not a survey and is not indtended
to be used as one.
Aerial photo -Spring 2010
120 60 0 Feet
City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
NOV032016
Use BLUE or BLACK Ink
For Office Use ^ z
Permit #:
Permit Fee:
Date Received: - 3-1
Staff:
2015/FIRE SUPPRESSION SYSTEMS PERMIT APPLIC ION
/
Date: / -/6 Site Address: J F-0 it4 eer ck.c4j i%6ec) a^-
Tenant: Suite #:
Name:
-firr r ccr r f Tn rs
(-F?C' Ca rISO/Pt )r.
Property Owner
Type of Work
Contractor
Address / City / Zip:
Phone:
Applicant is: Owner f/ Contractor
Description of work: )c)levs S oY) def r s/e, c) oc 1— As�
Construction Cost: 560
Name: �r� TC� ILCt®Y'V License #: C(°' iKcD
Address: 3000 (vt•-e —V+ I k Ed. City: 4-1 le 6A. _
State: AV Zip: s'ci l 7 Phone: 65- (-77
lg%y
Contact: Email: atrO ScV1�5 '� cow
Estimated Completion
Date: / 5-
FIRE PERMIT TYPE
Sprinkler System (# of heads [3)
Fire Pump
Other:
_ Standpipe
DESCRIPTION OF WORK:
FEES
Commercial
$60.00 Permit Fee Minimum includes State Surcharge
WORK TYPE
_ New Addition
Alterations — Remodel
Other:
Residential
*If contract value is GREATER than $2,010, Surcharge = Contract Value x $0.0005
If the project valuation is over $1 million, please call for Surcharge
$100.00 Residential New (includes State Surcharge)
3/4" Displacement Fire Meter - $270.00
Educational
Contract Value $ Soo . 00
=$
=$
_$
(2o bo
Q. 00
6d 60
Permit Fee
Surcharge*
TOTAL FEE
= $ 00 Fire Meter
$
UC
TOTAL FEE
**Requirements: 2 complete sets of drawings and specifications, cut sheets on materials and components to be used
I hereby apply for a Fire Suppression System permit and acknowledge that the information is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Eagan and with the Minnesota Building/Fire Codes; 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
which requires a review and approvallof plans.
Tiof
Applicant's Printed Name
FOR OFFICE USE
REQUIRED-
96
PurnpTest Central''Station
Conditions of Issuance:
Permit Reviewed by: