4672 Marquis Pt11 City of Eau
Tenant:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
Date: S
RESIDENTIAL
Furnace
Air Conditioner
Air Exchanger
Heat Pump
Other
RESIDENTIAL FEES:
$60.00 Minimum Add -on or alteration to an existing unit (includes $5.00 State Surcharge)
$100.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) =
COMMERCIAL FEES:
$75.00 Underground tank installation /removal (includes $5.00 State Surcharge)
$60.00 Minimum (includes State Surcharge)
- 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
(i.e. a $10,010 - $11,010 Permit Fee requires a $ 5.50 surcharge)
Applicant's Printed Name
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2012 MECHANICAL PERMIT APPLICATION
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Site Address: ` 7 N4 la a Q V t S 12c2
For Office Use [f
Permit #: /t
Permit Fee:
Date Received:
Staff:
Suite #:
Use BLUE or BLACK Ink
Name: —ilk f'1 ( - S A T ! , E' �'� " ' C / � J Phone(( I `i q / 7 f
Address / City / Zip: G 7 Z. (\ - Q `Z ' L J 5 I e C,& E c.5 err S s Z
Name: /VVJA Low S WA; 4 / ` j i License #: S I S fl
Address: ? S f Lvoi-- N,in`j f oN '4 W� L City: / / cJ_f1 *-PL
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State: P--I Zip: S V1 3 Phone f ?) ZS 6 '° f 0 Q
Contact: '.A/\ (O Uv Email: AAQ.ACowca-KOC 1 Cam Cys / • /• e - T
Replacement Additional Alteration Demolition
Description of work: R PIG C2 o f c) - fir, L Q
COMMERCIAL
New Construction Interior Improvement
Install Piping Processed
Gas Exterior HVAC Unit
Under / Above ground Tank ( Install / Remove)
OR
Applicant's Signature
TOTAL FEE
Contract Value $ x 1%
=$
=$
_$
Permit Fee
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.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 pecrtt; that the work will be in accordance
with the approved plan in the case of work which requires a review and approval of pia
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CITY OF . EAGAN WATER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:.
Eagan, MN 55122 DATE:
Zoning: — No. of Units:
Owner: —
Address:
Site Address:
Plumber:
Meter No.: — Connection Charge:
Size: Account Deposit:
Reader No.: Permit Fee:
agree to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges: -
��/ Total:
B Date Paid:
Date of I nsp.: I nsp.:
CITY OFr SEWER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: —_ No. of Units:
Owner: -- —
Address:
Site Address: --
—
Plumber: — —
I agree to comply with the City of Eagan Connection Charge: —
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
By __ Misc. Charges:
Date of Insp.: — Total:
Insp.: Date Paid: