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: