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4212 Rahn RdPROPERTY OWNER Name: / ,14,/ /9 ( / "6 \ - Phone: CONTRACTOR Name: i L License #: ( Address: .i City: State: Zip: Phone: Email: TYPE OF WORK New Replacement Repair RRuild Modify Space Work in R.O.W. — _ _ _ /��� /OG Description of work: (f k6 _ ( VZ_ l Oa til PERMIT TYPE COMMERCIAL ! New Construction Space - ' P6412_ _Modify Irrigation System ( _ yes / no) (_ RPZ / PVB) _ _ �• Rain sensors required on irrigation systems • 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: $50.50 Minimum (includes State Surcharge) OR Contract value $ x 1% Required - If Permit Fee is less than _ $ Permit Fee on ALL new buildings and boulevard irrigation systems 4 = $ Radio Meter Read $1,000, surcharge is $.50 = $ Meter(s) - If Permit Fee is > $1,000, surcharge increases by $.50 for each $1,000 a $1,001- $2,000 Permit Fee requires a $1.00 surcharge). = $ State Surcharge $1,000 Permit Fee (i.e. Following fees apply Call the City's Engineering when installing a new lawn irrigation system. $ Water Permit Department, (651) 675 - 5646, for required fee amounts. $ Treatment Plant $ Water Supply & Storage $ State Surcharge TOTAL FEES $ City of Doi 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 Use BLUE or BLACK Ink Permit #: / _--( ..� 74 Permit Fee: Date Received: �U Staff: L 2010 COMMERCIAL PLUMBING PERMIT APPLICATION Date: Site Address: 7" � j ii' t Tenant: Suite #: CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454 -0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org 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 plans. x Applicant's Printed Name x Applicant's Signature Page 1 of 3