4466 Lakeshore Ter Use BLUE or BLACK Ink
City EaRn t 1� For Office Use C' 2 Cit of RECEIVED � Permit#:_- /3 b
3830 Pilot Knob Road AUG 2 z 2016 I Permit Fee:
o�
1 I
Eagan MN 55122 I
Phone: (651)675-5675 Date Received:
Fax: (651)675-5694 1 �• I
1 Staff: I,p
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2016 MECHANICAL PERMIT APPLICATION
❑ Please submit two(2) sets of plans with all commerci I applications.
-Date:" Site Address:
Tenant: Suite#:
Stti'e, 2 In r ` Name: d. 1 �6 �� Phone:
Address/City
.
Name:
O _License#:
Address: �,�IM/
j�
�tbarr city:
��
N
l State: r'/Vll Zip: �� Phone:
Contact: v��! Email: �'� ✓' �� � t he r�lJ'y�
" 4 New placement
rAdditional Alteration Demolition
M� f
" pk Description of work: LIB' � L� J
CC3TF Zoofmcaamted nd Tnund ounte 1.rnecfianrcalze" uipmer t s iegiiired to se�sur ened X-1
, adeeasotttae �ciranir [lnsetarr infcrrraitronm�cfrrittez( creeiiirm #ho�ts
RESIDENTIAL COMMERCIAL
F ace
New Construction interior improvement
Air Conditioner install Piping Processed
Air Exchanger Gas
r Exterior HVAC Unit
_Heat Pump [ Under/Above ground Tank Install/_Remove)
Other
RESIDENTIAL FEES
f $60.00 Minimum Add or alteration to an existing unit, includes State Surcharge
is $100.00 Residential New, includes State-Surcharge _ (�(J r- TOTAL FEE ..
COMMERCIAL FEES
Y
I Contract Value$ x.01
$60.00 Permit Fee Minimum
$70.00 Underground tank installation/removal = Permit Fee
i
t
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 conforman ith 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 tff� I t a permit;that the work will be in accordance
with the approv�ed1 Id,
dlan in the case of work which requires a review and approval of plans.
App[ cant's Printed Name Applicant' Signature
tF,0R_'OF,FICEaU:
.Required, Reviewed y..: :Bate;
Underground Rough"'tn` Air-Test Gas,Service'Test n-floor Heat Final HVAC`Scraen rrg