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3900 Rahn Rd� � � N EFt s; r (,i2 - Z2C� - _79. Sa Name: • �� a �, c� �S Phone: � Address / City / Zip: °{dO 'J'9......a-An , i � - Name: $ c (\ L ^} .c. 1" ten ,A License #: Address: tF., t5 L. yk•;r $\- 5.3' \& City: ( r State: NA N. Zip: S t.o 7- Phone: b t Z 2 Li - ^7i - t $ �1-c °j L- Contact:..../`3 n �� kt__— Email: Ocn * . U.--c> \ ilas Q_ Y N•,- c..<<. — C a E WORK New Replacement Additional Alteration Demolition Description of work: 1 ] nd nto .` n i l ii meit i t (redd to h screened 'by City s creening -m ods eth Pr: Mr TY PE err RESIDENTIAL 1C Fumace COMMERCIAL New Construction Interior Improvement Air Conditioner Install Piping Processed Air Exchanger Gas Exterior HVAC Unit Heat Pump Under / Above ground Tank ( Install / Remove) _ Other _ RESIDENTIAL FEES: $60.00 Minimum Add-on or alteration to an existing unit (includes $5.00 State Surcharge) Y© burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) _ $ 6 5 TOTAL FEE $100.00 Fire repair (replace COMMERCIAL FEES: $75.00 Underground tank installation $60.00 Minimum (includes State /removal (includes $5.00 State Surcharge) Surcharge) $10,010, surcharge is $ 5.00 surcharge increases by $.50 for each $1,000 Permit Fee requires a $ 5.50 surcharge) OR Contract Value $ x 1% = $ Permit Fee - If the Permit Fee is Tess than = $ Surcharge - If the Permit Fee is > $10,010, Fee = $ TOTAL FEE (i.e. a $10,010 - $11,010 Permit 4 City of hp 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 2012 MECHANICAL PERMIT APPLICATION ❑ Please submit two (2) sets of plans with all commercial applications. r) J 2 o a cJ Date: C (y ` 12_ Site Address: 3 c1 O O Tenant: 0 0 .--\ S � (--43) r Applicant's Printed Name CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454 -0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.o I hereby acknowledge that this information is complete and accurate; that the work will b conformance wi the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work i of to start witho t : permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. (0L .) &- For Office Use Permit #: 0 2 Permit Fee: 60 -X Date Received: Staff: Suite #: Use BLUE or BLACK Ink J 4 Road leg Ri j 7 iiktAlAtrittig t r: et .. c ! - . is 1 - 4104M 0 t0 stotpll w*b M1 tom' of llostoo Sir ' 1. Chotateit4 132 t CfiTY a AGAN "' x ' P #({ *ice x 41 — 6 7°- ( MN 55121 „ f 7,.85 ©w010: " Afitheig 41, Pharnber 6-885 55339 ' ' ' 1QQ.00 I era. II. owe** 'oath the City of$. u C J or.•. .4 5- fit F.:. 111..06181 .„ Su4 ,Vat. tom: 'nap ; r ` / / a A∎1 r.. DOI Ankh 218-722-8033 p.1 Use BLUE or BLACK Ink t ForOfriceUse----_-__- t i l l City of Eajan ~ Permit Fee: 3 966 ~ 3830 Pilot Knob Road I i Eagan MN 55122 I Date Received: I Phone: (651) 675.5675 I I Fax: (651) 675,5694 1 staff. 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 51 f3 Site Address:?VY- /gd0'l Unity ~oRLS I Name: ~Y.~iw Ph one: cash 7.37-?/G9 Resident/ o~ Owner Address I City I zip:~a 7.8 gjdA/' 1QeA1S ' 177A4 ..5~,~/o7a t Applicant is: _ Owner Contractor t Type of Work i Description of work: iQ- P ~O I Construction Cost: o03.6a Multi-Family Building: (YesI No - e Company: Z2Z;0C r`&SF,0;V e7 Contact: ~S /z/Jl f A~ess'l/ '7- , VIE. 14/. City: 'dt:;; %S Contractor I Q bO 5tate:/J1 I zip. 53-3F!V3 Phone: ~<a -,goo E License I~BGadl3l9lYo Load Certificate ili: If the project. is exempt from lead certification, please explain why: (see Page 3 for additional information) V 1 II l 1 COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING 1 In the last 12 months, has the City of Eagan Issued a permit for a similar plan based on a master plan? 3 t _Yes _No If yes, date and address of master plan: i i Licensed Plumber: Phone: I Mechanical Contractor: Phone: r Sawar a Water Contractor: Phone: ' NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the informatyon may be classifled as non public if you provide specific reasons that would permit the City to conclude that they are trade secrets_ CALL BEFORE YOU DIG. Call Gopher State One Call at (651) I54.0002forprotectim against underground utility damage. Call 45 tours before you intend to dig to receive locates of underground utilities. www.aooherstateonecell.orq hereby acknowledge that this information is complete and accurate; that the wo.'k will be in conformance with the ordinances and codes of Lie City of Eagan; that I Lsiderstand this is no a permit, but only an appfication for a cerrnit. and mrtc is not to start without a permit: that the work will be in accordancewuh the approved plan in the case of work which requires a review and approval of plans. Exterforwork autthorind by a building parait issued in accordance with the Minnesota State Building Code must be complotad within 180 days of permit Issuance. , Applicant's Printed Name Applicants Signature Page 1 of 3 ~-d