3904 Rahn RdCity of Eagan
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 t" ll commercial applications.
Date: & — (y ' - Site Address: 3 6 1 0 52,1" n „ a
Tenant: c. ko`c C1 o a,r \ S D W !\t_r
Address / City / Zip: °r,DO 7. e 143
Address: tSt. 5 f _ - S t-. (- City: e'N,i.naw .d1 S
State: M N. Zip: 3 SL-lO Phone: b t Z 72-f -4 `t g Lct
New Replacement
RESIDENTIAL
Fumace
Air Conditioner
Air Exchanger
Heat Pump
Other
License #:
Additional Alteration Demolition
Description of work:
COMMERCIAL
New Construction Interior Improvement
Install Piping Processed
Gas Exterior HVAC Unit
Under / Above ground Tank (_ Install / _ Remove)
Name:
RESIDENTIAL FEES:
$60.00 Minimum Add-on or alteration to an existing unit (includes $5.00 State Surcharge)
$100.00 Fire repair (replace bumed out appliances, ductwork, etc.) (includes $5.00 State Surcharge) =
COMMERCIAL FEES:
$75.00 Underground tank installation /removal (includes $5.00 State Surcharge) OR Contract Value $ x 1%
$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)
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.00pherstateonecall.
I hereby acknowledge that this information is complete and accurate; that the work will be confor n. wit li e 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 t to sta w' out ermit; 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
Appll'ba Vs Sigel ature
For Office Use
Permit #: /0
Permit Fee:
Date Received:
Staff:
Suite #:
Phone: t 2' Z2-0 79_ $6
Use BLUE or BLACK Ink
..0 0
TOTAL FEE
= $ Permit Fee
_ $ Surcharge
$ TOTAL FEE
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9.16 -$ 33 ! " 11� 1`"*
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l " amply with as C . E s: ha , +625:
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[tea of i e� ` - Total:
' /0 l r5.. • c>fft Paid.
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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
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