3584 Blue Jay Way - Unit 204 Use BLUE or BLACK ink
I For Office Use
City of EaRah *t 1 Permit#: I�
3830 Pilot Knob Road � i Permit Fee:
Eagan MN 55122 MA�
Phone: (651)675-5675 Date Received:
Fax: (651)675-5694 I
I Staff:
L__---______
2016 MECHANICAL PERMIT APPLICATION
❑ Please submit two (2)sets of plans with all commercial applications.
Date: "�` �° Site Address: , < T �I/( �/ � d
Tenant: Suite#:
i s f Sli:�entlOWll@C Name: Ben �l�� Phone:
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Address/City/Zip: 2 � (� S �pQ3
Name: LQ `1 L License#:
71rlttt3r Address: l� r City:
State: Zip: t:�;LIobl Phone:
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Contact: y V I Email: lrid:� � 4 J C k4l
New Replacement Additional Alteration Demolition
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f r>ae f lUA k< Description of work: It 4A
[O E 2aof nountecl, nd= ui, unounte lam6&hanrc'- u menfirs�� urrexi to�bescreened:b �2r
Feasi heefl%q,zhaniodhl7s�- Irlfodffnfff o trail on Fr- itted�eenffM etE�nds
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RESIDENTIAL COMMERCIAL
I F,i�rnace New Construction interior Improvement
_ i
�e1.C17Lt � i _Air Conditioner x instpll Piping Processed
a '° Air Exchanger
Gas .Exterior HVAC Unit
Heat Pump
Under/Above ground Tank C—Install/_Remove)
Other
RESIDENTIAL FEES
$60.00 Minimum Add or alteration to an existing unit, includes State Surcharge
t $100.00 Residential New, includes State Surcharge TOTAL FEE
L
COMMERCIAL FEES Contract Value x.01
1 $60.00 Permit Fee Minimum
$70.00 Underground tank installationiremoval = $ Permit Fee
1
_$ Surcharge
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-withoyt a permit,that the wa 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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Applicant's Printed Name Applican Signature
FOR:O'FFICE.tUSE -
"Reguired: