1312 Town Centre Dr
Use BLUE or BLACK Ink
j I-----------------t
For Office Use I
I Permit
City of Eap I `~G I
RECEIVED j Permit Fee: V I
3830 Pilot Knob Road I
Eagan MN 55122 FEB 11 2014 Date Received:
Phone: (651) 675-5675 j
Fax: (651) 675-5694 j I
I Staff: I
2014 FIRE SUPPRESSION SYSTEMS PERMIT APPLICATION*.
Date: Site Address: tVWtJ Q4Pgk o Y~
Tenant: ~f ^r Suite
Name: C 11~-~, l~ Phone:
~Z
r 1
PrO~+er Address /City /Zip: I `7- ~l~
4141
'T- Applicant is: Owner Contractor
' Description of work: `@ Wl r I.-L k%" op D TO UL-3v<
Construction Cost: Estimated Completion Date:
Name: ~7%A Mul A_J A-AL 4 License
W~ ~1 s
~ tractor Address: t1/LnA Kr,C.VA4 City:
- -
State: Zip: Phone:
Contact:" mail:
FIRE PERMIT TYPE WORK TYPE
- Sprinkler System of heads _ New Addition
Fire Pump _ Standpipe _ Alterations _ Remodel
Other: Other:
DESCRIPTION OF WORK: Commercial _ Residential _ Educational
FEES
Contract Value $ X.01
$55.00 Permit Fee Minimum = $ r Permit Fee
*If contract value is LESS than $10,010, Surcharge = $5.00 r
**If contract value is GREATER than $10,010, Surcharge = Contract Value x $0.0005 Surcharge*
***If the project valuation is over $1 million, please call for Surcharge = $ TOTAL FEE
3/4" Displacement Fire Meter - $260.00 Fire Meter
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 approval of plans.
Applicant's Printed Name Signature