Suite 940 - Samsonite �� ___ Use BLUE or BLACK Ink
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�((,� � For Office Use I
I a �� �
• � � Permit#: � N� I
Cl�� of����� � �� �
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RECEIVED � Permit Fee: �
3830 Pilot Knob Road I
Eagan MN 55122 JUN 1 � I
� Date Received: �
Phone: (651)675-5675 g ��1� I r �
Fax: (651)675-5694 � Staff: �
I
. ___���_ �______��J
2014 MECHANICAL PERMIT APPLICATION
❑ Please submit two(2)sets of plans with all commercial applications.
Date: �,���,�%'T�Site Address: � 1�� h v�'4'' "- " �I
Tenant: � Suite#: "'7 �
Resident/Owner Name: Phone:
' Address/City/Zip:
Name:��Q.,�I �/f'��(��.y�ir,/ License#:
COI1t�aCt01' ' Address: ��,�,,�-�/s�� �2h1' City:
State:�Zip: SS� �►' � Phone: ��v?�� ��'`✓���
Contact: ���`�E�+�l� ��.��[, EmaiL ^ s� ,.
New Replacement Additional �teration Demolition
Type of Work Description of work:
NOTE: Roof mounted:antl ground mounted mechanical equipment is requiretl to be screenetl by City
: Code: Please contact the Mechanical Inspector for information an permitted screening methods.
,; RESIDENTIAL COMMERC/AL
Fumace New Construction _j�l'fiterior Improvement
P@CI111t T�/p@ —Air Conditioner Install Piping Processed
Air Exchanger Gas Exterior HVAC Unit
_Heat Pump Under/Above ground Tank �Install/�Remove)
Other
RESIDENT/AL FEES
$60.00 Minimum Add or alteration to an existing unit(includes$5.00 State Surcharge)
$100.00 Residential New(includes$5.00 State Surcharge) _$ � TOTAL FEE
COMMERCIAL FEES Contract Value$ � /D� x.01
$55.00 Permit Fee Minimum �C .�-
$70.00 Underground tank installation/removal =$ .JS^ 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 =� � (�'f 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.
X �JG��°,�'`� ��,�'t _. X ,;.
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ApplicanYs Printed Name Ap ant's gnature
FOR OFFICE USE /
Required Inspections Reviewed By: Date:S�_��
Underground Rough In Air Test Gas Service Test In-floorHeat ° Final HVAC Screening