3168 Alden Pond Lane SEWER * WAT PERMS r°
CIT1f F EAGAN GA ° . , �E tE :�
CITY OF AG Rd. PEAMI`t DATE V/9/10
WATER PERMfT; # 4097 SEWER PE AIY #
P.O. Box 21199
Egan, MN 55121 ; � METER. . � RECEIPT �
READER # - 8.0.14ECE#T -DATE
METER SIZE S$41 t : C 3961
ISSUE DATE _ PRV _ BGX3 11% PUMP
- :SITE ADDRESS 3:268 Alden PERM
- �' tf � ds' I
LOT 1 .--/AILOCK 1 SECISUB d .
APPLICANT: --SEWER L'"R ATER` — TAPS
x . .
� ha .� � �
ADDRESS: COMMIIND . ESIDENTIAL
CITY, lf, STATE
#0360111 , , 55113 _
PHONE 0 431,4404 , NEW
EXISTING'
PLUMBM Imo
ADD "? E 2 E AGREE TO M PIX WITH dTY EIS
CITY, STATE - i = CO II ALAN QtIfDNtIA
SS M * . S TORE WHENVE"f ER ISSUED -
CITY, STA r sev$5134,, zip -
PHotie
EA EE I. I is ; s e m r FO R STORM CONTACT
.� a t
, • • Use BLUE or BLACK Ink
---------�
� For Office Use �
�� V! � � ���"�� "� � 1 Permit#: / 1
�� � � � � I
��� '� � � Permit Fee: . I
3830 Pilot Knob Road ����F I
Eagan MN 55122 � � _ �
Phone:(651)675-5675 �,,t� I Date Received: �
��°:_._____'.__!__.__�._ � ,,,/� �
Fax:(651)675-5694 - � �/�
� Staff: �
�����������������J
2014 MECHANICAL PERMIT APPLICATION
❑ Please submit two (2) sets of plans with all commercial applications.
Date: q' �' �� SiteAddress: ��$ ��� �n � a � � ���-
Tenant: L*� � c1 Suite#:
�Resident!?Jw�er:,�`� Name:�k� � �� �or� S � � Pnone: � 5 t- 5$'"r 3 3$`�
Address/City/Zip: 3i f>$ h 1� � n lo�-.+ 1�.0
Name:�S z C� � -,t.c�\ 1a c�,.�.n� ���r' License#:
Address: ��Sl S `t_ �i t `'` 5Z- s�.�` �F City: �� �� -,«,O o 1�S
�GO�'1�1'8�'�GP"'� �
° State: M n Zip: S 4 t-C D� Phone: t�7 t L- 7'�-�'i`t$�Q l
": Contact: ��n c� ��-- EmaiL �
�
New � Replacement Additional Alteration Demolition
�� � � �� f��f S S 6Z ls r0 'ZO,u o� � TJ�J�
'[���'�'�pr� Description of work. � �
N�?�'E Rcacr�rri�unts���!�'s����+�iin#+a�i�r��h�tt�F�wi'r��i������`�����►+��y�#y`
��tf�:< Ple�i�:cci�i�'I�et2�e�nr���F t����ar.�r� �i ����k���s:
RES/DENTIAL COMMERCIAL
�Fumace New Construction _Interior Improvement
Air Conditioner Install Piping Processed
� P�rt�ijt'�y�e�� — � — � —
_Air Exchanger Gas _Exterior HVAC Unit
_Heat Pump Under/Above ground Tank (_Install!_Remove)
Other
RESIDENTIAL FEES
$60.00 Minimum Add or alteration to an existing unit(includes$5.00 State Surcharge) /� �c7
$100.00 Residential New(includes$5.00 State Surcharge) _$ C�� TOTAL FEE
COMMERCIAL FEES Contract Value$ x.01
$55.00 Permit Fee Minimum
$70.00 Underground tank installation/removal =$ Permit Fee
'If contract value is LESS than$10,010,Surcharge=$5.00 =$ Surcharge*
"*if contract value is GREATER than$10,010,Surcharge=Contract Value x$0.0005
""'If the project valuation is over$1 million,please call for Surcharge =$ TOTAL FEE
I hereby acknowledge that this information is complete and accurate; that the work will be ' onformance with t rdinances 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 ot start with a it;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 ����, l�� �,��- X
Applicant's Printed Name Applic t' ignat e
FC�R"4�FtC;EUS� ` � °�`��
� $
F fi � �
i �.5 ? .r�.t+a.a �F��` �
��C�Ei11'�C�it18p@1.`�IC�t$ i � ` .� �`��+�IA����" � "' �' ^ a^` � '���
11tu3B�9rc?Un�i F�vtlgh Iti �,�,,,�tr;"F�$s� ,-�;�,.�,�58�F+e��'�t ` �rt�iaOr He� „�,�,'� � r ���,h ;