unit 106 Use BLUE or BLACK Ink
For Office Use /p, I
City of�a�aIl REC�I��� i Permit#:' -1 O�
Fee:
3830 Pilot Knob Road I Permit 00 • 00 I
Eagan MN 55122 L 9 n
Phone:(651)675-5675 FEB 0 12016 I d 201, Date Receive d 201( OI 11
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Fax:(651)675-5694 I Staff: s6 I
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2016 MECHANICAL PERMIT APPLICATION
❑ Please submit two(2)setts of plans with all commercial applications.
Date: �f L!I('a Site Address: °)1`l D'�r JCsV L-3) 4 4/(3Q,
Tenant: d.ka Suite#:
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Name:y� raie A��ei Phone: �a 1,7
Address/City/Zip: ° I�� J /�1�-� 1)3
Name: y r� �-�,���..; n , ('�,o(.i,�, License#: M O Z�S
of
Address: 64i m City: I"a
State:f_Zip: 3, Phone: �rI-34a-Y'f1'(e
Con
tact:%Jd If(-ec Email: 4,4
New �Replacement Additional Alteration Demolition
Type Qf Description of work: L ,,•H .
1011 `Roof rna a ndttItE111 ..•� �.s tJ� - tad i
: ode Plead at►iCakl r �a
PIN
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RESIDENTIAL COMMERCIAL
AZFurnace New Construction _Interior Improvement
Air Conditioner _Install Piping _Processed
Air Exchanger _Gas _Exterior HVAC Unit
_Heat Pump _Under/Above ground Tank l—Install/_Remove)
Other
i
RESIDENTIAL FEES
$60.00 Minimum Add or alteration to an existing unit, includes State Surcharge
$100.00 Residential New, includes State Surcharge =$ TOTAL FEE
COMMERCIAL FEES Contract Value$ x.01
$60.00 Permit Fee Minimum
$70.00 Underground tank installation/removal =$ Permit Fee
Surcharge=Contract Value x$0.0005
_$ Surcharge
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 lodJ ,6l-f`ra x
Applicant's Printed Name Applicant's Signature
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PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA137000
Date Issued:06/10/2016
Permit Category:ePermit
Site Address: 3584 Blue Jay Way 106
Lot:023 Block: 04 Addition: Lexington Place 1st
PID:10-45050-04-023
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Steven W Bader
3584 Blue Jay Way Unit 106
Eagan MN 55122--220
(612) 384-4097
Air Rite Heating & Ac Inc
6935 146th Street West, #3
Apple Valley MN 55124
(952) 683-1900
Applicant/Permitee: Signature Issued By: Signature