3244 Alden Pond LaneSERVER & WATER PERMIT
CITY OF EAGAN
3838 RCA Krick Rd.„,
P.O. Box 21199
Eagan, MN 55121
OPPICE.USE ONLY
PERMIT DATE 9122/89
WATER PERMIT * 111917 SSR PERMIT #
METER '# E P RECEIPT
READER # P. RECEIPT DATE_
METER SIZE &W Receipts€.370/
MATE'. PRV .. _.: BOOSTER PUMP
APPLICANT: no
ADDRESS..
CITY, STATE Rci l 1 e 1 . M'I rip 5S I
PHONE 631.3254_
PLUMBER: • : earlil
ADDRESS. Y
.
CITY, STATE - ` ., _ ► 55369
REQ
to/S."—EWER TAPS
RESIDENTIAL
424.
OWNER: 2722 *lrtneiship
ADDRESS: 171 i City Rd. `B
CITY, STATE :.: Roseville zip I 55113
PHONE. 66
ETON
ty of Eaaali
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use
Permit #: /3' //(G/
Permit Fee: (L/ '
Date Received:
Staff:
2016 MECHANICAL PERMIT APPLICATION
❑ Please submit two (2) sets of plans with all commercial applications.
Date: i9 Z I ' ( '6 Site Address: 32-1-k y -A \ 6 a. r1 7 o S '
Tenant:
Tac\ $ , (1 \
Suite #:
Name: Phone:
Address / City / Zip: 32_1-'19. /A k ? O'1 c,)
Name: S , (7 . k «-4k � a- F}<(License #:
( 615 S. LIN s ` S - 5„,+._ A City: Nt • n r► c c d 14.$
State: (', Zip: 55' t O 7 Phone: t9 12-- 1 Z' - t $ `zc1
Address:
Contact:
r1n` ,L Email: Gn nc- Go,"v
New X. Replacement Additional Alteration Demolition
Description of work: (o. _ _ Cu.rr"t �r 5 $ STA '- 50145
RESIDENTIAL
Furnace
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 State Surcharge a:
$100.00 Residential New, includes State Surcharge = $ 60 TOTAL FEE
COMMERCIAL FEES
$60.00 Permit Fee Minimum
$75.00 Underground tank installation/removal, includes State Surcharge
Surcharge = Contract Value x $0.0005
If the project valuation is over $1 million, please call for Surcharge
Contract Value $ x .01
=$
=$
=$
Permit Fee
Surcharge
TOTAL FEE
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 ggrmit; that the work will be in accordance
with the approved plan in the case of work which requires a review and approval of plans.
Applicah 's Signature
x V cc4
n e 5
Applicant's Printed Name