3635 St Francis Way, Unit CCity of Eau
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
Date: a icy � I
1
Tenant: u l J rr n
Applicants Printed Name
Permit #:
Suite #:
Use BLUE or BLACK In
Permit Fee: 63 - D l✓
Date Received:
Staff:
2011 MECHANICAL PERMIT APPLICATION
Site Address: 3 (03 C3 Si- F ra-nd S Way U n (+-
J
RESIDENT / OWNER
CONTRACTOR
TYPE OF WORK
PERMIT TYPE
Name: Phone: G1 5 L Fc — q /q6--
Address / City / Zip:
Name:
Address:
Contact:
State: ALL Zip: 551-1 t
N Bev k "'V
Email:
Phone:
License #:
City: t T Li u c Pa/ J
( 07697
New ✓ Replacement Additional Alteration
Demolition
Description of work:
d mechanical equip
apector;fo nform
/ RESIDENTIAL
/Furnace
Air Conditioner
Air Exchanger
Heat Pump
Other
New Construction
Install Piping
Gas
COMMERCIAL
Interior Improvement
Processed
Exterior HVAC Unit
Under / Above ground Tank ( Install /_ Remove)
** When installing/removing tank(s), call for inspection by Fire
Marshal and Plumbing Inspector
RESIDENTIAL FEES:
$55.00 Minimum Add - on or alteration to an existing unit (includes $5.00 State Surcharge)
$95.00 Fire repair (replace bumed out appliances, ductwork, etc.) (includes $5.00 State Surcharge $ 1. 00
AL FEE
COMMERCIAL FEES:
$75.00 Underground tank installation /removal OR Contract Value $ x 1%
$55.00 Minimum (includes State Surcharge)
= $ Permit Fee
- If the Permit Fee is less than $10,010, surcharge is $ 5.00
- If the Permit Fee is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee = $ Surcharge
(i.e. a $10,010 -$11,010 Permit Fee requires a $ 5.50 surcharge)
= $ TOTAL FEE
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.uopherstateonecall.orq
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 pl. I
t o ft.
App 'ants Signature
FOR OFFICE
Requi ..�
Under Grou
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