2975 Center Ct � __ Use BLUE or BLACK Ink
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��4U�lI� �� `�\�`'�� L�'` ��' I Permit#: a � I
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� � � Permit Fee: 4*'W I
3830 Pilot Knob Road � J � �
Eagan MN 55122 � I ��, �� �
Phone:(651)675-5675 � Date Received:
Fax:(657)675-5694 � I
� Staff:
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2014 MECHANICAL PERMIT APPLICATION C`���"'
❑ Piease submit two(2)sets of plans with all commercial applications.
Date: -� �C• � ��� `'1 Site Address: [7�� �� ��.J�-�r" �'�'•
Tenant: �.7°/2`-T"" ►�1�.��,�u re s Suite#:
��` ��' � Name:_�.F-�i A��� o �I`-1�..,- e S Phone:
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' ' � �„ .; Address/City/Zip:
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' : �; Name: M� I n�/ ��'� /�AN e•4 C. License#: ����D�S
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' �::� Address:__�ok ! 5`I City: ��'�,o.nS
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�:. � State: `�� Zip: ��� �� Phone: �s� ^9 /3 –��� /
:_...: ' Contact: �t� �"< ° l..� EmaiL �t� � �r/qE/ �c�+�ru'�'C�L, e� '�
� �� , New Replacement Additional �Alteration Demolition
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�`� ���/� Descriptionofwork: �pi,r�c� �N�RaA-ed N*��� t1,��r�, �;nrN���- 4'- �
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' ' : �� RESIDENT/AL COMMERCIAL
', _Fumace New Construction � Interior Improvement
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_Air Conditioner _Install Piping _Processed
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' _Air Exchanger � Gas Exterior HVAC Unit
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- Heat Pump UndeNAbove ground Tank �Install/_Remove)
� Other
RESIDENTIAL 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$ j��°�' '� � x.01
$55.00 Permit Fee Minimum ,_
$70.00 Underground tank installation/removal =$ r �Q Permit Fee
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*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 acknowiedge 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 permi4;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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ApplicanYs Printed Name Applica 's�ignature
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