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City of Eaali
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
Use BLUE or BLACK Ink
For Office U �f
Permit #: ��/ `�
Permit Fee:
(b
Date Received:
Staff:
2014 MECHANICAL PERMIT APPLICATION
❑ Pleasf s mit two (2) sets of plans with all commercial applications.
Date: Z/ (l 201 (a %►
h is ,c4c)
Tenant:
Site Address:
Suite #:
Name: 40,7 Z' Phone: o 2 ° 3
Address / City / Zip: 1-1 "? / 2) 51 . ✓ $ e ;r.. c vs,/ ST
Name: /44 of c.& LLB
License #:
Address: Z(o b S LJ - 44 (l*Jei, /3
1 City: Fv!'nSJi I t_k
State: it). Zip: 5533-1 Phone: qSL-2c(2 -or) b .
Contact: t L Email: a..41-1 �i t► L S e ,,to 1 . c .1_
■
New ✓Replacement Additional Alteration Demolition
Description of work: IAS I'r. f Good _, lei c4._ c° (r-
RESIDENTIAL
/Furnace
1/ Air Conditioner
Air Exchanger
Heat Pump
Other
COMMERCIAL
_ New Construction Interior Improvement
_ Install Piping Processed
Gas — Exterior HVAC Unit
_ Under /Above ground Tank ( Install / Remove)
RESIDENTIAL FEES
$60.00 Minimum 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
$55.00 Permit Fee Minimum
$70.00 Underground tank installation /removal
*If contract value is LESS than $10,010, Surcharge = $5.00
* *If contract value is GREATER than $10,010, Surcharge = Contract Value x $0.0005
** *If the project valuation is over $1 million, please call for Surcharge
Contract Value $ x .01
$
_$
_$
Permit Fee
Surcharge*
TOTAL FEE
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.
x
Applicant's Printed Name
x had
Applicant's Signature