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1634 Donald CtCity of Eap 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454 -0002 for protection against underground utility damage. you intend to dig to receive locates of underground utilities. www.gopherstateonecaliorq I hereby acknowledge that this information is complete and accurate; that the work will be in conf Eagan; that I understand this is not a permit, but only an application for a permit, and work is with th a proved plan in the case of work which requires a review and approval of plans. U U 1 [ vike 3e +''1 Applicant's Printed Name plicant's Signature Use BLUE or BLACK Ink For Office Use D c7 Z. -3 Permit Fee: � Date Received: — 2 ed-6- e— Permit #: Staff: L ����'' 2012 MECHANICAL PERMIT APPLICATION Date: 2 ` Site Address: y li v 14 Cr Tenant: ;5 i4 { Suite #: Name: roc ct (.;(6 It rt L'' Le_ur4,t,c10s (C t Phone: CS/ 1 ,98 ) ( Address / City / Zip: )63(.4 a y1G4 i' CI &g em ,' /Yv ._�S /; Name: AO/ / A T IINC 4r- 6vtcli t iilAy, License # I mo 3 9c 7 Address: 2122,80 -T re f ` 4 v� o& Sy- I City: tcc si The I State: (/' 4 fib Zip: ) ( Phone: L/34I3 Contact: 4L1' VCp°l ir'r f? t" Email: i tr jct A. 1 v-r `e SeVI("1 YeritG 60-4 New Replacement Additional Alteration Demolition Description of work: �''kGe vvtt ainci th LA, vc.at •f Gvte # 'NOTE: Roof mounted and ground mounted mec equipm i required to be s by Code. Please contact the Mech Inspector for information on permitted scre method RESIDENTIAL Furnace Air Conditioner Air Exchanger Heat Pump Other New Construction Install Piping Gas COMMERCIAL Interior Improvement Processed 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) TOTAL FEE COMMERCIAL FEES: J/' $75.00 Underground tank installation /removal (includes $5.00 State Surcharge) OR Contract Value $ / c '- GU x 1% $60.00 Minimum (includes State Surcharge) - If the Permit Fee is Tess 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 manc with the ordinances and codes of the City of out a permit; that the work will be in accordance 4-5 Call 48 hours before FOR OFFICE USE Required Inspections: Reviewed By: Underground Rough in Air Test Gas Service Test In -floor Heat rinal : HVAC Screeninc, CITY OF EAGAN WATER SERVICE PERMIT 3795 Pilot Knob Road PERMIT NO.: EayGn, MN 55122 DATE: Zoning: -- - — No. of Units: - Owner: — -- -- Address: - Site Address: Plumber: - -- - - -_ — Meter No.• — Connection Charge: Size: _ Account Deposit: — Reader No.: — — Permit Fee: agree to comply with the City of Eagan Surcharge: Ordinances. Misc. Charges: Total: — — By Date Paid: — Date of Insp.• ~ Insp.• CITY OF EAGAN SEWER SERVICE PERMIT 3795 Me Rood PERMIT NO.: Elgin', MN 55122 DATE: Zoning: _ — No. of Units: Owner: — —_— Address: — — — — — — Site Address Plumber: I agree to comply with the City of Eagan Connection Charge: Ordinances. Account Deposit: Permit Fee: -- — Surcharge: By Misc. Charges: Date of Insp.: Total: _ Insp.: _ Date Paid: