3450 Denmark Ave
Use BLUE or BLACK Ink
For Office Use
I
I Permit Z, lop 01?
a~ I
400. City of Eap I
3830 Pilot Knob Road Permit Fee:
Eagan MN 55122 I Date Received:
I
Phone: (651) 675-5675 I
Fax: (651) 675-5694 Staff:
2014 COMMERCIAL PLUMBING PERMIT APPLICATION
❑ Please submitt two (2) sets of plans with all commercial applications.
Date: 7 -f Site Address: 3 11 ~c VJ~-~'~Y`n ~ ~V ~►~~i~~ I ~
Tenant: F,J~. ~d Suite
Property
Owner Name: Phone:
Name: f^ tMGJ° rv~Z License ~-c
Contractor Address: ! l 0 f' K- C 4-,r- S. gD ~ J Zi
City: 2 ~.i State: i ~ p: ~ 113-
Phone: Email:
Type of Work - New - Replacement - Repair < Rebuild - Modify Space _Work in R.O.W.
Description of work: h r a- ~ ( T" Z- 5 / le h-r PLI\k~s G N t
COMMERCIAL New Construction Modify Space
Irrigation System yes / _ no) RPZ / _ PVB)
• Rain sensors required on irrigation systems
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 picking up meter.
Domestic: Size & Type Fire: 1
Avg. GPM High demand devices? Yes No Flushometers Yes No
COMMERCIAL FEES Contract Value $ X.01
$55.00 Permit Fee Minimum
_ $ Permit Fee
*If contract value is LESS than $10,010, Surcharge = $5.00 = $ Surcharges
`*If contract value is GREATER than $10,010, Surcharge = Contract Value x $0.0005
""If the project valuation is over $1 million, please call for Surcharge = $ TOTAL FEE
Following fees apply when installing a new lawn irrigation system $ Water Permit
Contact the City's Engineering Department, (651) 675-5646, for required fee amounts. $ Treatment Plant
$ Water Supply & Storage
$ State Surcharge
TOTAL FEE
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. \
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 which requires a review and approval of pla
x MG x
Applicant's Printed Name Applicant's Sig ature
FOR OFFICE USE Approved By: Date:
Required Inspections: Under Ground -Rough-In Air Test -Gas Test -Final PRV Required: Yes No
Meter Related Items: Meter Size Radio Read Staff:
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