1944 Shawnee Rd
Use BLUE or BLACK Ink
For Office Use
pi
City 0 Ealan V 1 Permit
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1
3830 Pilot Knob Road Permit Fee: I
Eagan MN 55122 SFP I fl j F
Phone: (651) 675-5675 3 010 i Date Received: 3
M I
Fax: (651) 675-5694 ~3 1 Staff: P~~ I
I
2013 MECHANICAL PERMIT APPLICATION
❑ Please submit two (2) sets of plans with all commercial applications.
Date: 9-ZE,_ l3 site Address: -1 Z~ i 1 :195 Z, r9yq 1,9V6 , 19YN 4
Tenant: 1/~ I(2.1 t9 t-'~ Suite
Resident/Owner Name: Phone:
Address / City /Zip:
Name: QrYZ~+[L. lA~iC ~-i_ License
Contractor Address: I(.,( A- City: &"s
I State: AJ Zip: 45533 .7 Phone: q5-2-- ?l e/ -Z 23
~~~~~~pr,~•,~c~f~,r~[c~/ GsY'-t
Contact: vE cxc`t [I1T Email: 514W5
New Replacement Additional Alteration Demolition
Type of Work Description of work: A&T79st- A-0 t'I-EPWL GA-s Ai p(.cAr 17-ny.A, 56a,- PAnnA* J
NOTE: Roof mounted and,ground mounted. mechanicahequipment is required to be screenedby City
Code. PIease, contact-the Mechanical Inspector for information on permitted screening methods.
RESIDENTIAL COMMERCIAL
Furnace New Construction _ Interior Improvement
Permit Type -Air Conditioner -Install Piping _ Processed
_ Air Exchanger Gas Exterior HVAC Unit
Heat Pump Under/Above ground Tank Install Remove)
Other
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) $ 70TALFEE
COMMERCIAL FEES
Contract Value $ ;ZoQQQ fit? X.01
.$55.00 Permit Fee Minimum
$70.00 Underground tank installation/removal = $ Permit Fee
"If contract value is LESS than $10,010, Surcharge = $5.00 S;~D Surcharge"
'*If contract value is GREATER than $10,010, Surcharge = Contract Value x $0.0005
"f the project valuation is over $1 million, please call for Surcharge = $ btu, OV 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.
Applicant's Printed Name ant's Sign re
FOR OFFICE USE /
Required Inspections: Reviewed By: _'~y_ Date: f~~ I I
Underground -Rough In F Test Gas Service Test In-floor Heat Final HVAC Screening
� Use BLUE or BLACK Ink
N1> [�-�/s1C,��-�`I�/� ,-----------------,
� For Office Use I
• G��t `� � � � Pertnit#: I� ���� �
�l�y ������ � , � � �_ �
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 � ,�� , ,, . '
�\ , t _
'�;���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.
��
x ��a n� �J �uC� �
Applicant's Printed Na icant's Signa e
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