3780 Grey Dove Lane- 3-t6s03 1-7. 317413178, 3180, 3184 .31 86 13-lalo D-Dve.
Use BLUE or BLACK Ink
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3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
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For Office Use
Permit #: 11 93.3(12(0
Permit Fee: 1Va.5. (69
Date Received: kO I 2..°1
Staff: .4:61i3)
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2013 RESIDENTIAL BUILDING PERMIT APPLICATION C
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Date: Site Address: -PA 3,,F3,8'0 I 3)81.) Unit #:
I
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Name:
Address I City / Zip:
Applicant is: Owner
Contractor
Description of work: L COco 4 -
Construction Cost: 09 aoo
Company: \e -104 -Ace...\
Ltr—
Address:
Phone:
Multi -Family Building: (Yes / No )
Contact y
City:
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State: Ai 'S("3"-13
cense #: tctio 44 5 Lead Certificate #: A.) -
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
Yes No If yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor
Sewer & Water Contractor:
Phone:
Phone:
Phone:
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. ,Nww.q,:-illEN qtateonecalf org
1 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 1 understand this is not a permit, but only an application for a permit, arid work is not to start without a permit; that the work witi be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
Applicant's Printed Name
Applicant's Signature
Page 1 of 3
4111/
City of Feel
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Date: I I
RECEIVED
JAN 082016
Use BLUE or BLACK Ink
For Office Use
Permit #: I Z,L"J W LIS
Permit Fee: Co 0. 00
Date Received:
Staf69
2016 MECHANICAL PERMIT APPLICATION
❑ Please submit two (2) sets of plans with all commercial applications.
Site Address: 3760 GkEyDove LA N
Suite #:
Tenant:
Name:
Address / City / Zip: S
Phone: 61 A•0 •7765
Name: K411 • vAc,
License .
Address: 30 iC.I LE STQeier City:ly trrLE CANADA--
State:M14 Zip: SG I 13 Phone: 651• 46-4. 354119
Contact: S ve-
Email: SU
New X Replacement Additional Alteration Demolition
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Description of work:
RESIDENTIAL
/furnace
Air Conditioner
Air Exchanger
Heat Pump
Other
New Construction
Install Piping
Gas
COMMERCIAL
Interior Improvement
Processed
Exterior HVAC Unit
Under/Above ground Tank ( Install / — Remove)
RESIDENTIAL FEES
$60.00 Minimum Add or alteration to an existing unit, includes State Surcharge
$100.00 Residential New, includes State Surcharge
=$
(!mob TOTAL FEE
COMMERCIAL FEES
$60.00 Permit Fee Minimum
$70.00 Underground tank installation/removal
Surcharge = Contract Value x $0.0005
If the project valuation is over $1 million, please call for Surcharge
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 wor 1s 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 approvalofa
p ns
Contract Value $ x .01
_ $ Permit Fee
= $ Surcharge
= $ TOTAL FEE
x t)el-titivntin
Applicant's Printed Name
Applicant's Signature