1914 Shawnee Rd Na ���1(�J-�/G�/�f oti Use BLUE or BLACK Ink
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3830 Pilot Knob Road ��� �O�T I Permit Fee: �
Eagan MN 55122 j / �
Phone:(651)675-5675 ��; � Date Received: /� �
Fax:(651)675-5694 � I
I Staff: �
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2014 MECHANICAL PERMIT APPLICATION
❑ Please submit two(2)sets of plans with all commercial applications.
Dat�:_l,V ' �° �� � Site Address: ����— I G��� �6������C.- h-� ' �C���6� � �`'�-�
Tenant: Suite#:
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' '" ��`� Name: �1.Q: �iLQ � Phone: �� D"1'-1' OI�
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��� � , �� Name:�Qf''�`1e� ��QC��I(�(ll�Z�-Q License#: �.��t`� h��6J�
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fy y � � Address: I�k I� e,11�'�,� �' �• City:��-br�S V l��l.Y_
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�,� �� State: �1v Zip: ����� Phone:����� �JI�OI� '�
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�,�,,� ���� Contact: I�l(i Email:Sh�C.1�. OL ��( �1 / I;� ��
{ � New �Replacement Additional Alteration Demoliti '
'."'T�pey,t7f'�i1f+DT� Description of work: � h�-�'1 C'JI -- j�
£ hi�ETE ��f tn�wc�b���r�gr�und na�unt$d rt���han�ca�equ�prr�ent i��qu�r��i to kkrGe s+creen�st�y C�y;
: ��de'. f�le��s�cnr�t���h�M��F��a�a��a`��P�r;#or�n�crrrna��n c�r�ermrit�d scr�nin���:f�iods.
�' RES/DENTIAL COMMERCIAL
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� „ ,F - ', _Furnace _New Construction _Interior)mprovement
y �� Air Conditioner Install Piping Processed
`.�_�+�Cltl���?��'� ��', — — —
� _Air Exchanger �as ✓�xterior HVAC Unit
�:� e��, — —
� �� _Heat Pump _Under/Above ground Tank �Install/_Remove)
���,z - ._ � Other
RESIDENTIAL FEES
�60.�3�J R4::s9mam Add or a!tsr�t�on to an existing unit(includes$5.00 State Surcharge)
$100.00 Residential New(includes$5.00 State Surcharge) _$ TOTAL FEE
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COMMERCIAL FEES Contract Value$ ���v��� x.01
$55.00 Permit Fee Minimum /
$70.00 Underground tank installatioNremoval =$ �'J'�U Permit Fee
"If contract value is LESS than$10,010,Surcharge=$5.00 _$ �•�� Surcharge*
*'If contract value is GREATER than$10,010,Surcharge=Contract Value x$0.0005
**"If the project valuation is over$1 million,please call for Surcharge =$ �, QO TOTAL FEE
I herebyacknowledge 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 ptan in the case of work which requires a review and approval of plans.
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ApplicanYs Printed e App nt's Signatur
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