3157 Alden Pond LaneSEWER & WATER PERM'
CITY OF EAGAN
3830 PiInt krIob Rd.
Eagan. MN 55122-1897
OFFIE:E Wie ONLY
PERMIT DATE 8 /
1:/829
WATERPERMIT # 10792
$12E B.P. RECEIPT # C 2995
►ATE 8.P. RECEIPTDATE 7(14189
_PRS/ BOOSTER PUMP
SITE ADDRESS " 3157 Aiden•
COT 8 BLOCK 2 REC/SUB
APPLICANT: ?Gse road CoDatrgct
ADDRESS' 1711 W. C9unty Rola
CITY, STATE ; Roseville `liN •Y .ZII 551,
PHONE 631-3254
Majar 'lifochanirs ," Tnr-
A0640. gigue»Y
Maple Grove . MN
414-468Q,
410/`.
C!ty of Pio
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Ur 11 (1
Permit #:
Permit Fee: Y!O. 04
Date Received: 12r/Ia/i7
Staff:
2013 MECHANICAL PERMIT APPLICATION
❑ Please submit two (2) sets of plans with all commercial applicions.
Date: r2--`' 1 ` 13 Site Address: 3 1 5 1 A Q c. n O^ U t� ^d-
1 r--,
Tenant: A\ [Jtn o,. $ r O w.n (n "-.. S
Suite #:
Name: 1 Q n ?O e, , O (,) ,-. `�o_n^.c Phone: is S (• 7 `- 6' el
Address/City/Zip: 3b 00 A i cl cn \. 0 d 1 c‘..,-,ccMt5S`T)
Name: Std, r, k - \ 1 \e ' r , 4 A% r License #:
Address: 1%iS F. Li Or 'S - Su`ic A City: M,knr,r r,,; G 1, S
State: (ice- Zip: S 5101 Phone: 6 I Z '(2-14- 1 cici
Contact: A c, ..,.z -
Email: OL K.TJkne_c
Qi ho (- cont
New Replacement Additional Alteration Demolition
Description of work: , • " 7
�T J
RESIDENTIAL
Fumace
Air Conditioner
Air Exchanger
Heat Pump
Other
COMMERCIAL
New Construction Interior Improvement
Install Piping Processed
Gas Exterior HVAC Unit
Under/Above ground Tank (_ Install / _ Remove)
RESIDENTIAL FEES
$60.00 Minimum Add or alteration to an existing unit (includes $5.00 State Surcharge)
$100.00 Residential New (includes $5.00 State Surcharge)
COMMERCIAL FEES
$55.00 Permit Fee Minimum
$70.00 Underground tank installation/removal
=s 60a1)
TOTAL FEE
Contract Value $ x .01
_$
*If contract value is LESS than $10,010, Surcharge = $5.00 $
*If contract value is GREATER than $10,010, Surcharge = Contract Value x $0.0005
**If the project valuation is over $1 million, please call for Surcharge = $
I hereby acknowledge that this information is complete and accurate; that the work will be it conformance
Eagan; that I understand this is not a permit, but only an application for a permit, and workq n to start wio
with the approved plan in the case of work which requires a review and approval of plans.
x
Applicant's Printed Name
x
App
Permit Fee
Surcharge*
TOTAL FEE
inances and codes of the City of
that the work will be in accordance
an Signa
ure