4635 1_2 Penkwe Way S. RIlI - of wits: ,1 U t ti Cs
Orrin Tilom3Scin Homes -
. - 4635'1 Penklee Way L3; B5 3 C fiidge III
Wenzel
' C+xu ecticn C ages 305.00 pd
too.
Account Wit:
S t et Pwm Fe ` 10.00 jd
4 r wlihi **O. +if Swrd+aia: . 50 did
misc. Ctw 60.00 pd meter
,,
Tow!:
,�' mate Pte:
Y of mod!'
i7 r 0 I'
Sit &f�___. 1 S 371 Mr2“ T' ,, f 2F 9 f"
Plumber: r .�
nfi<► Wrs air Eat &Wm Connection Charge. 42 5 00 F � __�-
Account Dowel
hrinit
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BY
Data of 1 " Misc. Charges:
'_ Total:
insp.:
Date Paid:
if-" 3' yr
S,a
��9 3�, �(a.�� , �,; ���' , ��v� � �a- Use BLUE or BLACK Ink
------:----____�._
� For Offlca t�se �
• j Rermit#: �� �
C��� of�a a� � ; . �� �
� �� Permd Fee: �. �
3830 Pilot Knob Road � � ' �
Eagan MN 55122 C � � Date Received: �
Phone:{651)675-5675 } �
Fax;{651)675-5694 1 Staff: I
f 1
'---- ----------'
� � 2414 RESIDENTIAL� BUIL.C)iN ,t'',� PERMiT APPLIC/�T1t�N
oar�:��-I��-�� s;�Add�s:_��3��' �'l� 3�"�J� /°���'� cv.�f unr�#�
IVame: �c��i�i'�� �'��. /�zx,r/}�7�t...- �p�e;
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� R�:S�C��i1fi1 .�
4W11�!' Address f City/Zip: !"i�`}���" �i�-'�
Appiicant is: Owner �Contractor
Description of work: ��'�' ��� �° t ��' "''����
Type�f 1lVork �
Gonstruc#ion Cost: ��<1�� Multi-Family Building: (Yes�/No_�
Company:��7YZs� 7°P �`��
_,��� �' [�sr1%�t�s�9•C��t�`'°'S Contact: _tJ ft� //��`�t�o�
COt1'tr�Ct01' Address:C��(�� ��'��,.,l���- L,',►-�� �°' city:�i ��'�- ����'�.-.
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State:�Zip: ���.:�,� �r J Phane:v j2�-��`�j`t'Email:,�►»►�y'1 JY C�,3�5'?�Gc��?�a��v��i r�
License#: l.�C ��`� �f 'T� ��c-_c.�,�-•
Lead Certificate#:!V�- i"°Y 1°>�i'1 t�,3 �°l�
!f the project is exempt from lead certi#ication, please explain why: (see Page 3 for additional information)
COMRLETE THIS AREA ONLY iF CONSTRUC7fNG A NEW BUILDING
�
In the last 12 mon , the City of Eaga�issued a perrnit for a simiiar plan based on a ma�ter plan?/'"^�
_,Yes _No If yes, date and addr s.,r�f master ptan:
�-.
Licensed Piumber: Phane�
Mechanical Cantractor: '
Sewer&Water Con# r: Phone:
N�3TL; ar�r#au�r�i�r�tlacurnen�s flaa#y�u strbmet�r�e ctarr�iafereaE ta�e pubJi����'a�rrr�tt�. �rfions r�f
ert�'�tnr�ta�an may;b+e�lass�d��non-p�b��c if you provieie�p�c'r�'rc r�sons tha�w3i�ld`�err�ari�t��e Ci�y t�-
cancf�de t�a�� are tr�rtl�e sec�e�`
GALL BEFORE YOU DtG. Catl Gophee S#ats One Call at(B51)454-�02 for protection against underground ut�7�y damage. Call 48 haurs
before you infend to dig to receive locates of underground utilities. www ponherstateonecatf orq
I hereby acknowledge that this information is complete and accurate;that the work will be in confoRnance with the ordinance,s and codes of#he Gity of �
Eagan;tMat! understanct#his is reot a permik, but only an appfication for a pe�rnit, and w�rk is not to start withou#a permi#; that the work will be in
accordanc�Hrith fhe approved ptan in the case of�rtc which requires a review and approvat ofpfans.
Exterior work authorized by a building permit iss�.�ed in accordance wFt�t the AAiRnesota State 'Iding�ode m�t be cpmpleted within 180
days uf permit issuance.
�f
X V ' � ,�� . X � ° . ° �
Applicant's P�inted Name ' ant's Signature
Page 1 of 3
•
pF� C r For Office use,
*'r )
:U N ►° ea A Z Permit#:
m' O / Permit Fee: (O
°if
• —Areseo i Date Received:
Yy.-
3830 Pilot Knob Road I Eagan MN 55122 Staff:
Phone;(651)675-5675 I bujldinainsoestlonsacitofeartan,com
•
2017 MECHANICAL PERMIT APPLICATION
❑ Please submit two(2)sets of plans with allcommercial applications,
Date: l�`6"l� G/ I
Sit/e�,A,Address: 6 7655- Pt n,k t4v i, ett.i
Tenant: Gsato&YS /"is f°r fL-S s #g
34,n:"Y'.^ 'F q•u'rl..S W' `'c,.,,,,�r.l a x.. Site#:
1''•Y-.N�;t�..v�4,.IM1�-• , '�i' 'JrS�tdP,,�p�'�''`µp��� M //w{��
•654.404,.-411.5,r40,001it11 & a,', ' _ .,, Name: 14.C.11� 01 $ Phone:
r 11t
� a :. r33 ,,ak w Address/City/Zip: rvvl W 0- ��0. i n
,i.40.4404:11-0,:yy,, �,4 e3tf
S PI"C' 1D,.`q•'p'�q a i; fir,,
•
'�' �: I �St.�r x I �f ,i Name: �� f ovta/t r� 'P/0.'�t�r �°
S 1;‘" icense#:
:ti
.:a r44 1,r�r•1 t � Address: CS-60 Pi z°wror", I �r City 5,t,.l b✓a'e r
k '
31 {1i I
3 /'°i. �5►, 0' 16" State. /yin Zi 5`rj`ry�]/
Iiy ,1 ., V " p' ✓ 1 P �GS`1� �3�-5��?a
4.,!h:',4004,3,,', # in p _
+ r� , Contact: vC kC . GSI i? ,? V
li` i lay h1yG+a + i'r
,,,,,kyr,,.01 ^ ( '4' New Replacement
,:tiq ,. 1•, T ,, _ Additional Alteration
Ip !'� dernolitio
'i"i� Y i�����to Description of work•t%'4 n OR 01 Re'.° i r .Y' r"' "f .- ''r
?�-4sAbyW'
y, 41109;''r14 tji.., h 1 ,,,., rX' .u,1 1 : .-'1,1.1;,'", i r f 1 � i -•.�� +� t- :ti i.G a. lur.:,.,. '
�. • f4 1( ::.4.-,-,-..,:l',,•-..-•--, '-'•-:-.;•; ,:,•:,•;I 1 yr ( 31Cµ."`, 1 7'' 14.p
li",.1> � r+ aa. y ?: .,,r- r J I'h11 ' P•.• ,, 4,C •,:•,51, ,..,'�-.`-: •&.. , NA "y e 1. 't
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, . -, SSbI 3+p'$,1•_)t,CS` rid.MrA�r14t����If��lf)f}tr�lt�rk��st-�}'�,FS.1^Ns�`ir1F,�.x.4. -�'jP5?SI�h�`�L'�:�'��r'�' '.:��+u�y'I
wl �� �.4I �t • : RESIDENTIAL COMMERCIAL
•
u.
- n,; ; LOA.954DA_� Furnace rev New Construction `Interior Improvement
vt: 00�.g:i;�t1 , 33 nS II p vement
`%W'e ' Air Con limner
-.r.?�aidi,t s4. �• -044:' /f Of rnN � Install Piping _Processed
`utr J z, ,:•,r .', 4 Air Exchanger JLA t'i t S Uyl h
+ ''1,44.,
, '1, � Gas AC Unit
yi. ,«�i, 1;�;�>.;`,.' �' ��r.�e�r�c �5��� 02 Exterior HV
' hl = ate , ,, ' , .„ _Heat Pump J�
40,-Ar.I 'tea , = 1 a e X S'rri� Under/Above ground Tank („Install/_Remove)
iv `,'4''3 ,:ti: Other ri ' ►0.rrD�J Kt,
RESIDENTIAL FEES :3;6 Vim) #6v Soj,
$60.00 Minimum Add or alteration to an existing unit,includes State Surcharge
$100.00 Residential New,includes State Surcharge _$ TOTAL FEE
COMMERCIAL FEES -
$60.00 Permit Fee Minimum Contract Value$ x,01
$75.00 Underground tank installetion/removal,includes State Surcharge =$ Permit Fee
Surcharge=Contract Value x$0.0005 =$ Surcharge
If the project valuation is over$1 million,please call for Surcharge =$ TOTAL FEE
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.cltvofeaoan.corn/subscrlr!e.
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 permit;that the work will be in accordance
with the approved plan in the case of work which requires a review and approval of plans. LA
1�t)Ck, I °U �� r` C4? ,
Applicant's Printed Name Applicant's Signature
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