3256 Dodd Lane VILLAGE OF EAGAN WATER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: No. of Units:
Owner:
Address:
Site Address:
Plumber:
Meter No.• Connection Charge:
Size: Account Deposit:
Reader No.: Permit Fee:
I agree to comply with the Village of Eogan Surcharge:
Ordinances. Misc. Charges:
Total:
By Date Paid:
Date of Insp.: Insp.:
VILLAGE OF EAGAN SEWER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: No. of Units:
Owner:
Address:
Site Address:
Plumber:
I agree to comply with the Village of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
By: Misc. Charges:
Date of Insp.: Total:
Insp.: Date Paid:
Feb 16 15 07:58a Dave's Heating and Air 763-789-8605 p.2
Use BLUE or BLACKlnk
�-----------------,
� For Office Use �
j Permit#: �.G ✓ �� i�. �
Cl�� Of�B��Il � Permit Fee: ' - (��� �
3830 Pilot Knob Road � I
Eagan MN 55122 i : I
Phone:(651�675-5675 � Date Received: I
I �
Fax:(659)675-5694 �
� Staff: �
�������� ��.�����J
2015 MECHANICAL PERMIT APPLICATION
❑ Please submit iwo(2)sets of plans with alE commercial ap plications.
Dabe:°� � � �a Site Address:�� �U�[ � ! /��LJ .s J �°7
Tenant: l��lr's �.�Q.0 `�' (X�� —aTd ^O7�v Suite#•
ResicfentJOwner Name: n S h-�` L+C_� Phone: �P�O� °? � ����
Address/City I Zip: �-� u �'t Ul . 4� .��o��
Name: hQ.S ��� � ��v License#� o��✓��d��
4 Address: �`�'�/ � �l./� City: �/�-l77�G�- Zj/1
� Contractor . /-
� State: �� Zip S I Phone: �3� �CP���
i Contact: �-(�%vl ��C�/ Email: u�LG� �G+(�S� �� �
New �Replacement _Additional Alteration Demolihon
Type of Work Description of work.' Y�i.f� CL n� /Yl � 7�� D � �!�/i�"
NOTE:Roof mourrted and ground mounted mechanicaE equipment is required to be scr ned by City
Code. Please contact the Mechanical I�spector for information on permitted screenir�g rrtethods.
RESIDENTIAL COMMERCIAL
�umace � New Construction _Interior Improvement
Pe�l'fl�TyPe . Air Conditioner _Install Piping _Processed
_Air Exchanger Gas Exterior FfVAC Unit
—���^�p UnderlAbove ground Tank (_Install!_Remove)
Other
RESIDENT/AL FEES
$60.00 Minimum Add or alteration to an existing unit(indudes$5.00 State Surcharge)
$100.0�Residerrtial New(includes$5.00 State Surcharge} _$ TOTAL FEE
COMMERCIAL FEES Contract Value$ x.01
$55.00 Permit Fee Minimum
$70.00 Underground tank installatioNremoval =S Permit Fee
"If contract value is LESS than$�0,010,Surcharge=$5.00 =$ Surcharge"
"If conhact value is GREATER than$10,010, Surcharge=Contract Value x$0.0005
'. "'`If the projec[valuation is over$1 million,please call for Surcharge =� TOTAL FEE
;
I hereby adcnowledge that this infonnation is canplete and accurate;that ihe work will be in oonformance with 1he adinances and codes of Ehe City ol
Eagan;that I undersland this is not a permit,but only an applica6on for a permit,and work is not to start without a permit;that the wwk will be in accordance
with the approved plan in the�ase of work which requires a review and approval of plans.
x ��� C . �ad�t� x ��.� ��'��
Applicant's Printed Name Applicant's Signature
FOR OFFICE USE
Required Inspections: Reviewed By: Oate:
Undergraund _Rough fn Air Test _Gas Service Test !n-floor Heat Final HVAC?Screening