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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