1936 Shawnee Rd Y
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kasb il6rMt: PERMIT - NQ .•
JF8122 DATE: � 1
No..of Units:
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Permit Freei .. _. I ,
Surcharge:
Misc. Charges:
Date i :f Total:
_ Date Paid:
g K SEW t< 'F AIT..
� ' ' Road PERMIT. NO.:
94114 IFt22 bi4TE:
na' Na. of Units _,
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Date of Insp.: , Total: , A
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� Use BLUE or BLACK Ink
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� For Office Use I
• G��t `� � � � Pertnit#: I� ���� �
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ry I Permit Fee: � �� I
3830 Pilot Knob Road �UN � � LO1� i i
Eagan MN 55122 I �
Phone:(651)675-5675 � i Date Received: �3 �
C3Y:
Fax:(651)675-5694 �
I Staff: �
L------- ---------'
2014 MECHANICAL PERMIT APPLlCATION
❑ Please submit two(2)sets�f plans with all commercial applications.
Date: � t� I Site Address: ��Z�' «`t� ���,1.(L�Cll� �1 UA�� M�
Tenant: Suite#:
j � Cl L �/1�r, 5 ���-S��`�+ ���
, Name: ��:U Q� �I��r l Cl� �I's�C��� Phone:
����#t� y ' i i ' r•
�,�� . `� Address/City/Zip: IZ�IC� I�`�� �}Q- �IrL��1SI�f II,L, YV1� ��33-7 _
������� , Name: ��12-�'�"l:�-1�—���'1��< � License#:����� �JQ l J� �
�� ryd �,� � � � f �, ( ,,1
�"j � �'��� Address ���'"l �.�[`C� �,C�• �• City:��5�(��, �l
� °' C� '�� �car t 2 ��J�- �f���
' F y State: �� Zip: �.J3� Phone:
� � ��F�N
lq���� ` Contact: C� EmaiL• YV1
����y �
New Replacement Additional Aiteration Demolition
��i � ,�� , ,, . '
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'�;���rf�i��C ' Description ofwork� �O�CQ, ) S 1'1 e s `�
y f� ��� %t+�T� �af ti��su�Mte�t-;�r�d�u�td�rr�n�sd„trie�ba��Ga{equip�ea��is,required'�.6�:s�c�er�ed t�y�#�y�t
� .�..'; : ' -��C�.de: f�ea��corrta��f#te�CFiariical 1r�spasc�s�r��tai`�;-.ir�#c�rmat�or�an:pe�?t�ri�ed,��ereen�rt��ne�l�d5.,..=`
RES/DENTIAL COMMERCIAL
� n f= " Fumace New Construction Interior Improvement
r�s — — —
�� Air Conditioner Install Piping Processed
� '��@fi�t���}� — — —
� , •, ': s _Air Exchanger Gas ✓ Exterior HVAC Unit
�����,�� _Heat Pump Under/Above ground Tank �Install/_Remove)
; , �y
�r�.` —
' j���.�... Other
RESIDENT/AL FEES
$60.00 IVlinimum Add or alteration to an existing unit(includes$5.00 State Surcharge)
$100.00 Residential New(includes$5.00 State Surcharge) _$ TOTAL FEE
COMMERCIAL FEES Contract Value$ �� Q - � x.01
$55.00 Permit Fee Minimum r �9
$70.00 Underground tank installation/removal =$ ��"� •v LL_Permit Fee
�If contract value is LESS than$10,010,Surcharge=$5.00 =$ g��� Surcharge"`
""`If contract value is GREATER than$10,010,Surcharge=Contract Vafue x$0.0005
""If the project valuation is over$1 million, please call for Surcharge =$ I ��r 1� TOTAL FEE
I hereby acknowledge that this infortnation is complete and accurate;that the work will be in confortnance 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.
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