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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 I Fax:(651)675-5694 I Staff: s6 I -----------------� 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#: �$�.��-+tar"►._:��� 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 ----------- ---------- ._. 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 { Mdt� 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