4596 Cinnamon Ridge Tr CITY Of EAGAN WATER SERVICE PERMIT
3795 Pilot Knob Rood PERMIT NO.:
Pagan, MN 55122 DATE:
Zoning: _
No. of Units:
Owner:
Address: —
Site Address: --
Plumber: _
Meter No.: _ Connection Charge:
Size: Account Deposit:
Reader No.• Permit Fee:
1 agree to comply w1;'the City of Eagan Surcharge:
Ordinances. . Misc. Charges:
Total:
By Dote Paid:
Dat of Insp.: 7
Insp.:
CITY OF EAGAN SEWER SERVICE PERMIT
3795 Pilot Knob Road
'Eagan, MN 55122 PERMIT NO.:
Zoning:
DATE:
Owner:
No. of Units:
Address:
Site Address: —
Plumber:
1 agree to comply with the City of Eagan Connection Charge:
Ordinances.
Account Deposit:
Permit Fee:
B Surcharge:
y Misc. Charges:
Dote of Insp.:
Total:
Insp.: Date Paid:
4/I/I°CityofEaau
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
MO :2 :7 ,21116
Use BLUE or BLACK Ink
For Office Use f
Permit #: G
Permit Fee:
10094
Date Received:
Staff:
2016 MECHANICAL PERMIT APPLICATION
❑ Please submit two (2) sets of plans with all commercial applications.
Date: 5 -2'1-1e
Tenant:
Site Address: W 59 rn n a r".0 n JR , se
c.. RAC e n-4 Suite #:
Phone: 65t -39S - SBgg
J
Name: R s tc� ,�.�0.� \' A.rA,r License #:
Address: 1515 _ y 1 S' 5.\ h City: M n ne-4.‘,0 1 �g
State: M t Zip: S S tt C3 7 Phone: 61 Z - 7 Z_ -t " 18 S °)
Contact: Email: a+ . n ne - Ne—o\ ne_r• @, 1-\ r"e•-‘, 1- C -o ^'1
New Replacement
Additional Alteration Demolition
Description of work:
RESIDENTIAL 1 95,/to
X Furnace Carr«r 58STf O'- S B,
Air Conditioner Ccarrte. r 2.4-tk31:13Z
Z-D'To P)
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 State Surcharge
$100.00 Residential New, includes State Surcharge
C U o c TOTAL FEE
COMMERCIAL FEES
$60.00 Permit Fee Minimum
$75.00 Underground tank installation/removal, includes State Surcharge
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
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 w. is not to start without per at the work will be in accordance
with the approved plan in the case of work which requires a review and approval of plans.
Applicants Printed Name
x
Ap
1
cants Signature