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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 �� • 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; � � � 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 ��'�- ����'�.-. ,r J"'�' d 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 ,5 • HNA `''' �1? '" h t u•~1 1 -.{1 T 1 # 44 ,a /� '� ': 7° 1•4, W ,: �4 ,-, TntK G,,), -r..,,4h31 RAY II,. i 'ey ' e l , . -, 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 d "3 P 9 i p .i � , :CFP3t�... ,t •.7= �i4.. ,2;' pail ''' ,,•. 4'i p` 1,4 ii r• '�.� ,.1, •-. 7 4r 2, i� 1 ,,��.. +� yi_ "a: L� t`.�:M!t11�' k.�3t!k a 1. �,3�;,3;. . ,'.�3?�S,r1Y�' j{{ .•� .,41 s•, I�',trrr•4.,, �.so." 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