1708 Meadow View Rd - Fire Alarm Permit Use BLUE or BLACK Ink
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� For Office Use . � �'/,:,�
� ' � �
� ♦��` � Permit#: l � Il,� i�
Cit of E� aIl � ��d � . � -� i
� � � Permit Fee: � �,`
3830 Pilot Knob Road �O I l ����
Eagan MN 55122 � RECEIVED j Date Received: —a3�/ ����/6-�/S
Phone: (657)675-5675 '
Fax: (651)675-5694 � � Staff: S� �-�
SEP 131015 !----------------��-l��05
2015 COMMERCIAL FIRE ALARM PERMIT APPLICATION �
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Date: �` ��'` �� Site Address: f 7U" � ����Ow �� � �`}`�+
Tenant: �{/�� Suite#:
��� �Name: � � �>vm � .�,f ���� ��hone: ��� �''lY (lo p
PI'Q�C#y C�41/ti@t' . Address/City/Zip: � �y> ��c' Gl�� �'La �- �$�`1.�� —
Applicant is: Owner Contractor
�.����,��,��,� Description of work: �if� �"l�i�+
Construction Cost: Estimated Completion Date: �
Name: �r�6�dQg�/P�� ��l.vri 1'Cr �icense#: �S 0!� '{97
�ontract+�r address: P� ��x ��o,� c�ty: �vr's�s��1�
State:�Zip: 5s"337 Phone: �52 Z�Z ��73
' Contact: ��'G-�T 3/�P��1' EmaiL D�� $`���'k������r , ���
�ew _Remodel
`�������' Addition Other:
Alterations
DESCRIPTION OF WORK: �Commercial Residential Educational
FEES Contract Value$ �J�� • � x.01
$60.00 Permit Fee Minimum ��'%-
_$ Permit Fee
Surcharge=Contract Value x$0.0005 =$ �� Surcharge"
If the project valuation is over$1 million, please call for Surcharge
_$ � 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 Alarm 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.
x ��'�'1� �I�'c�Gt' X '�G�
ApplicanYs Printed Name Applicant's Signature
�0�2`�FF�C� USE' Re�rtewret�8�: '" ' ��•� �`� '
Required lnspectians. Fto�tgh-ln ��in�l ' Fir�At�rr�t�est