4060 Magnetite Pt - Site SurveyCITY USE ONLY
PERMIT #: RECEIPT DATE:
APPROVED BY: , INSPECTOR
COMMEftCiAI. MECiiLALNICAl. PERM1T APPLICATION
CITY OF EA6AN
3880 PILOT KNO$ ltD
EA6M, Mft 55122
651-6$1-4675
Please complete for: ail commerciai/industrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
DATE:
SITE ADDRESS:
OWNER NAME:
TENANT NAME (IMPROVEMENTS ONLl):
PHONE #: -
(AREA CODE)
WAS THERE A PREVIOUS TENANT IN THIS SPACE? Y N. NAME:
INSTALLER:
ADDRESS:
CITY:
PHONE #: -
(AREA CODE)
STATE:
ZIP:
WORK TYPE: New construction Install U.G. Tank
_ Interior Improvement Remove U.G. Tank
_ Processed Piping
5pecifyNature of Work:
When installing/removing underground tank, call 651-681-4675 for inspection by Fire Marshal and
Plumbing linspector.
Fees: 1% of contract price OR $50.00 minimum fee, wluchever is greater.
Underground tanlc removaUinstallarion = miaimum fee
Contract price: $ x 1% _$ (Base Fee)
State surcharge
TOTAL
$
calculate at $.50 for each $1,000 Base Fee
SIGNATURE OF PERMITTEE
Updated 1/O1