1256 Town Centre Dr Use BLUE or BLACK Ink
---------------,
� For Office Use I
� /.- `• � �
U�� U��� �it _ � Permit#: t�� �J�� i
� � � Permit Fee: ! ✓% �� �
3830 Pilot Knob Road I �
Eagan MN 55122 j
j Date Received:
Phone:(651)675-5675 � I
Fax:(651)675-5694 �
� Staff: �
__��_�__�___�____J
2015 MECHANICAL PERMIT APPLICATION
❑ Please submit two(2)sets of plans with all commercial applications.
Date: Site Address: � 2-��D 1 OGv1� (�N17"P�E ���
Tenant: �1- �' S Suite#:
� � \�
�� , ��
`��� .� � � �," Name: Phone:
� ��
� °° �; �3 ➢ Address!Ci /Zi
s: , k tY P_
e� C nr � , /�/� � ( �� ,� /
�
� ` � � Name: �� $ .X7✓l5 JV�1" /"�.hNt— �G License#: ✓J�(� -�'! ��
�
�� �� t a ,, ,, , / //
1 � Address: ��7 � s� J t- /�l)� _City: �/1��v �11�1�7
� ,�
� � State:�Zip: 3.52. Phone: �SZ- Z� �P3�� —
A�; `�� � ` � Contact: �(�C [��gv'c2I� Email: ^ S ✓1�2.�
� � E �,
> ���
New �Replacement Additional Alteration Demolition
;
�
"���' ,'� *"�� Description of work L�
�� � �
<���� � ��"���l��f�� ' �'�� , z �� � � ��� ;��� ����+
� �. R\' k�.�' a�;����*S ���� ;�� � �� ,.:'/ ��� ,/ �.
.... .. .�.. .. . ...: ... ..: „ ,;.,.,
, ,.:,�• .,.,;; � . ,aa.. rc,_ , , , .,.
� � 3�
� � . ������ � ` ' ' RESIDENTIAL COMMERCIAL
� 1 ���� u. �
'" ° _Furnace New Construction _Interior Improvement
�\�� ; —
� ;� ���,, Air Conditioner _Install Piping _Processed
�
� ...�� ���`� `�, Air Exchanger Gas �Exterior HVAC Unit
� � � —
j. ;,y Heat Pump Under/Above ground Tank �Install/_Remove)
� � E �� �:' 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$ 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 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 \JD�e�� �� �/�('c� x
ApplicanYs rinted Name � Appli nt' Signature
j�+a � � �
� �'�iir�� � � � ,� � �\Y�\�y�l Y� ��� \�,y� �� ���/ i F 4+�� �� ��. �ty� �
� �.�����#�i��' .,: ,�.� r ��� � ��'� �/�% ���.: �i�k,-�^?"-f'f�
9 � � r �
,�,, . , ; s� :� ' �"r`_'
, . _ �[ _ „��,, ,>�,, -�y L �[ '� s
_..,'� ���a\�� � ��€� .,�; .; ,�:,.�'�t 5�„{���[ 4`\c G 'fl��,���� '�'6i,.� E,� h�"i� ��..
��
E[
..-. ....... . . „ ,� „ :.. �, , ��; .. , ..,,,��� ��. ��1 �