unit 201 � �� ��
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Use BLUE or BLACK Ink
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�� U! 11� � f ���' �/ � j Permit#: �v7. �/ ��� I
3830 Pi�t Knob�aa SEP 0 2 2014 � Perrnit Fee: ��- � i
Eagan MN 55122 I �
Phone:(651)675-5675 ��r, �,�. � Date Received: �' ��J I
Fax:(651)675-5694 "-'-��----- � � I
� Staff: �
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2014 MECHANICAL PERMIT APPLICATION
❑ Please submit two(2)sets of plans with all commercial applications.
Date: �S t J`' Site Address: P �� I� � �0� �-'�
Tenant• �O Vl r.�Vl ��a— Suite#• ��
� �i � °� � ,��� Name: ��Yl ��C�"1,��'G�J � Phone: ���^ ��� ��� ��
��F�eSit�en#/�Wlie[ "
Address/City/Zip: �' �
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�' Name: d- License#: � � I
{ Address:_��a� ��Q.Jf (�)�I �� l"j {� S� City: t�5 � �l �
�? �UI���'��'�O�` ~�,
_ i State: �'� � Zip: ���"✓Phone: �P� ( ' �"� ��"' �� � �
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� Contact: Email: l� �Le.YC•C.�I� ����
�� ; New � Replacement Additional Alteration Demolition
;�.�
��Ty��,���{/��� � Description of work: �
f „� �� ` �CY�'E��Eca���n�ed�t��t�t��unrt�+���t�d��cFrantc�l�quipm��tt9s�e�q�������ie'scree�r��abY�ity �
; ` � �od�z�leas������e Alle�h�l�i�t�ns�s�c#c��r;�i�i�infi�t'I�',�, � ����trt��tetl sc�e ���l,i±��od�,� s
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�� °" RESIDENTIAL � COMMERCIAL �
'! x Fumace _New Construction _Interior Improvement �'�
;�y��,���� �� ,�Air Conditioner _Install Piping _Processed �
_Air Exchanger Gas Exterior HVAC Unit
—
� _Heat Pump Under/Above ground Tank (_Install/_Remove)
Other
RES/DENTIAL FEES
$60.00 Minimum Add or alteration to an existing unit(includes$5.00 State Surcharge) �v
$100.00 Residential New(includes$5.00 State Surcharge) _$ �� ° TOTAL FEE
COMMERCIAL FEES Contract Value$ x.01
$55.00 Permit Fee Minimum
$70.00 Underground tank installation/removal =$ Permit Fee
*If contract value is LESS than$10,010,Surcharge=$5.00 =$ Surcharge"
*"`If contract value is GREATER than$10,010,Surcharge=Contract Value x$0.0005
**"If the project valuation is over$1 million, please call for Surcharge =$ 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 1 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.
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Applicant's Printed Na ApplicanYs Signature
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