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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 �