1922 Shawnee Rd Na ���1(�J-�/G�/�f oti Use BLUE or BLACK Ink
� For Office Us���� I
������ I I
���� U������ � � � Permit#: �
/� � w I
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: �
L-------- -------�
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#:
�� . � ' � � � �
' '" ��`� Name: �1.Q: �iLQ � Phone: �� D"1'-1' OI�
����1@l'����8�'� � n /�, j �7
` ����.��s .
�.: ;; ,� Address/Citv/Zip: ����lJ �� �lL�• � �d.i�LSI�I � (l. ��1.� �J�3 /
����N.,,.
x�� �
" , ' • -
��� � , �� Name:�Qf''�`1e� ��QC��I(�(ll�Z�-Q License#: �.��t`� h��6J�
����%fi �� � {^ I � 1 I ,
fy y � � Address: I�k I� e,11�'�,� �' �• City:��-br�S V l��l.Y_
,����tra��r��, � �k � r� q I
�,� �� State: �1v Zip: ����� Phone:����� �JI�OI� '�
::,;fi,��.::,,�., ��.
/ `P I
�,�,,� ���� 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
� ` s
� „ ,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
�
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.
x _��1Gf�G �Q�C� x
ApplicanYs Printed e App nt's Signatur
��`�R���r4�+������ ����� �r_ �3�3 _ „o"��"�rk�c ��� '� � .
i �� � s. : . ��y �-a � - '�
�B�Kt[�B`C�¢�lt��Gti!t?11� �j�,�� 4 / / ��� ����'�,�a1ti$1tiR$��r�' `��� �...�� i r°z#�� �� .
..• E `' ; ; , t r , � u ,. �" j
�-`,�r�'��r�roun�i ���,�,�n AirT��t �;�as,Seru'�z�7�t.. tn-�t�ai�"� ��F�n�l.;� E�����;�er�n�