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3450 Highlander DrDate: City of Eapp 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Tenant: RECEIVED JUL 1 11 2011 Use BLUE or BLACK Ink Permit #: %pa! `y Permit Fee: .6- £2 0 Date Received: Staff: 2011 MECHANICAL PERMIT APPLICATION Site Address: 34a2) km \ O in Suite #: RESIDENT / OWNER CONTRACTOR Name: yi 1 e r P�rV^ r-�-St-{-qgp ,' -1 c -t-'t \O.c'Cj-Qv- .E or> Address / C�� � g� Name: _ Dan Wohlers Southside Htg. & A/C _ # ?—LTL SLA 7 q E7 6950 W. 146th St., #106 Address: _ Apple Valley, MN 55124 __. city: State: (952) 431-7099 Contact: j..111 \ . C° Email: TYPE OF WORK New ✓Replacement Description of work: Additional Alteration Demolition PERMIT TYPE RESIDENTIAL Furnace Air Conditioner _ Air Exchanger _ Heat Pump Other COMMERCIAL New Construction Interior Improvement Install Piping Processed Exterior HVAC Unit Gas Under / Above ground Tank ( Install / _ Remove) ** When installing/removing tank(s), call for inspection by Fire Marshal and Plumbing Inspector RESIDENTIAL FEES: '$'S5.00 Minimum Add-on or alteration to an existing unit (includes $5.00 State Surcharge)TOTAL FEE $95.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) $ 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 Surcharge - If the Permit Egg is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee =$ (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. CaII 48 hours before you intend to dig to receive locates of underground utilities. www.00pherstateonecall.arq 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. Applicant's Printed Name Applicant's Signature Jun. $, 2011 2:47PM SELA ROOFING )ThurrCity ofEapo pate: 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 C No. 6530 P. 26 Use BLUE or BLACK Ink 657.70.1:67.4707 Permit #: 9'4/ f Permit Fee; f3.3q...e95 Date Received: Staff. 2011 RESIDENTIAL BUILDING PERMIT APPLICATION/1,, Site Address:4w� g• �c�g�t� R� . RESIDENT 1 OWNER T f — Name; _Li 1 1I i / 4 r ! t ) .i i 1L «;, P1 //__ I r I (Pi #C Address 1 City I zip: � �' � � / ' 1 ' 1 � fig. 'f Applicant is: Owner Contractor TYPE OF WORK Description of work: 1- % ..c' 7 /� 01ikiz Le- 1-4(5 1 r UU (J Construction Cost: fu Multi -Family Building: (Yes i No ) CONTRACTOR ' Company: AriA or i Ai ' ( j , Contact: LL/l — & —161 Address:4/OQ 1t-LLOe r )tvo. City; CST. 1-6(A-6 State: l & Zip: 6541 l9 Phone: 4914-9)&,,—/ql� License #: 1 0 D Lead Certificate #: IV %r 4560(.'3q, If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) In the last 12 months, Yes No If COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING has the City of Eagan issued a permit for a similar plan based on a master plan? • yes, date and address of master plan: Licensed Plumber: Mechanical Contractor: Sewer & Water Contractor: Phone: Phone_ Phone: NOTE:.Plans and supporting. documents that yousubmit are considered. tobe public infor'ritebon. Portions of theinformation may be classified as non public if you provide specificTeasons that•,would permit the City to . conclude that they are trade secrets. - - 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.gor herstateonecall.orq I hereby acknowledge that this information is complete and accurate: that the work will be in conforrnance 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 errnit; that the work Wit be in accordance with the approved plan in the case of work which requires a review and approv of plans c 9y4- Applicant's Printed Name pplicants Signature Page 1 of 3 Ne