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3865 Gold Pt BUse BLUE or BLACK Ink 411' City of Eapil 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 1Vt- 0 31.01'l For Office Use Permit #: Permit Fee: Date Received: Staff: 2012 MECHANICAL PERMIT APPLICATION ❑ Please��submit two (2) sets of plans with all commercial applications. ' r0 Date: f /7 Site Address: 33 6S ( /� Tenant: 'ld a 4,7 ,% Phone: Suite #: i? Address / City i Zip: f�%/x��✓h��� (-����1/`- Z Name: _ i� i� "Sed'l License #: Address: �l! / &irIi 7 dtis� Q G City: /�� State: �! 5- JZip: � Phone: cc-- -07 V. Contact: Email: New eplacement Additional ;/� Alteration Description of work: rvr0" 6 .r''�� NOTE Rc r>naurtted ns #und t ' irr anica1 epuipkrlt� Code ; lease con ecfrpectorfor i fcormadpe RESIDENTIAL Air Conditioner Air Exchanger Heat Pump Other Demolition COMMERCIAL New Construction Interior Improvement Install Piping ^ Processed Gas Exterior HVAC Unit Under / Above ground Tank ( Install / Remove) 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) _ $ [p6.3 TOTAL FEE 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) = $ 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.ciogherstateonecall.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 plans. cc- t6:61.4.1 Applicant's tinted Name p icant's Signature CITY OF EAGAN WATER SERVICE PERMIT 3795 Pilot Knob Road PERMIT NO • Eac,n, MN 55122 DATE• Zoning: No. of Units• Owner• Address: Site Address• 3 8(e Si 3 YL 5- 3 8 61T S'h 7 i Plumber: Meter No.: Connection Charge• Size: Account Deposit• Reader No.: Permit Fee• 1 agree to comply with the City of Eagan Surcharge• Ordinances. Byp Date of Insp.: 7'Zr9'`8 Oi( Misc. Charges• Total Dote Paid• Insp • CITY OE EAGAN SEWER SERVICE PERMIT 3795 -Pilot Knob Road PERMIT NO.: Edgan, MN 55122 DATE: Zoning: No. of Units: Owner: Address: Site Address: ---- Plumber: 1 agree to comply with the City of Eagan Connection Charge: Ordinances. Account Deposit: Permit Fee: 8 Surcharge: Y Misc. Charges: Date of Insp.: Total: Insp.: Date Paid: Use BLUE or BLACK Ink 3115 gel PtI3VIA 2013 RESIDENTIAL BUILDING PERMIT APPLICATION) waspz -3$l;o'3 q j 1� Date: 1 Site Address: � - 1 e t . 1R r i , I unit # 38T 3 12'33S (pS fr j P Name /� 11 Address / City / Zip: 3$ GO d, yoliN+ Applicant is: Owner 4 Contractor Description of work: Q e,(0 Q-F Construction Cost: �� 4K 0 0 City of Eapli 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 vilks For Office Use ILt—itt° j%, Permit Fee: �J 1 �"7 Permit #: Date Received: Staff: �nP � 1�A J� I'it2s. W till'►$ 4 el Phone:1Q51 a T b Be-b r5 1E3, As ��1 g 1 h, (`�'J Sc I 37b1 CC ) Multi -Family Building: (Yes %Q / No Company: I lam. `6j1S UCt 6 Contact: Address: t ' (D Geit State: ✓ v, N Zip: 5SC71 Phone: License #: (3 C 03 4-0 Ta_La Err "Si City: kaSS Ella 1(JD"i• (ft-ts� Lead Certificate #: If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? Yes _No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Sewer & Water Contractor: Phone: Phone: 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 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. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. x N� l ILA-;- g ol/eCK, Applicant's Printed Name x lic nt's A pp Signature )64, Page 1 of 3 L 15 2020 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 (651) 675-5675 I TDD: (651) 454-8535 I FAX: (651) 675-5694 buildinginspections a(�citvofeagan.com For Office User 2 Permit #: lid '4 ✓J Permit Fee: • J t —T-c Date Received: Staff: 2020 RESIDENTIAL BUILDING PERMIT APPLICATION Date: % " ®2® Site Address: Unit #: J Resident! Owner Name: Waled tP WoCCIA ►" Phone: v �� I� �Sf 66id 'r.._ `L B4a.7 1 a Address / City / Zip: 31 4 513 J Applicant is: Owner iG Contractor Type of Work ta.tet.a.ih. 3 wei,404,.s ► t 0•6r t it 11 MVP, see Me% Description of work. Construction Cost: /O/ 700 Multi -Family Building: (Yes (' / No ) Contractor Company: 1347 etg fe r T o rS Contact: doh.' 274-2.10 F .p Address: S 184S. rA a m.s4-r7e. le Stru a 4- r+. 1 City: 11 4 p 1 Pica 4. State: ► t 0 Zip: 55-3 S9 Phone:, to 3 - 7-1 om • Email:] O 1 & Q be t3 a lic ere r~s . coo, 3 72. License #: 6C-3244 2, rIt Lead Certificate #: If the project is exempt from lead certification, please explain why: In the last 12 months, Yes No 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? If yes, date and address of master plan: Licensed Plumber: Mechanical Contractor: Sewer & Water Contractor: Fire Suppression Contractor: Phone: Phone: Phone: Phone: NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets., You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the Clty's webslte at www.citvofeagan.com/subscribe. Exterior work authorized by a building permit Issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit Issuance. 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.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 plans. x So\A.v. i‘Azio fig Applicant's Printed Name