1278 Town Centre Dr - 180 Use BLUE or BLACK ink K
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For Office Uae I I
,1( ..EIVED Permitm /`"7,- .� /0
City 0f BB Il m Permit Fee: &e. 4..S. 1
3830 Pilot Knob Road " 0 MAY0 9 2017
Eagan MN 55122
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Phone:(651)875.5675 Date Received: 5-9 -17 C_.
Fax:(651)675-5694
" • '' Staff:
2017 MECHANICAL PERMIT APPLICATION
❑ Please submit two(2)sets of plans with all commercial applications.
Date: `?-'7 " I / Site Address'f1 lix\` ..
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Tenant: gG Suite#: I 7)/y
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' " Name: �- ��/7GL Phone: T�cd '7 5 4' 2 3 3 -711R
l'4,;'; x a'( 'I Address/City I Zlp: .. :
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.),,,,Ir, tSH ya,, II' r! Name: �• M � 1 .. License#:
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r �, J, Address: _1I� _ ""�'.' City: I'il�24 01r5
i '; tip, State: / . Zip: qli Phone: j12 f" 321
-.4,.,-,.,,,,. Contact: DAvl kY 10 Iz d Email: L_ : t 1 fdA f , '�''t
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: 1, ' 'QIP " }l Jr {> 'New, Replacement Additional Alteration Demolition
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Description of work:
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ah' " ?1H Pc"Ip.1 {r ).:',44,4‘.4.4,q,„ ...4,'.:,,, pI(, I, I I II Gam/(
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1 REs4pENTIAL COMMERCIAL
ti`" '`' ; Furnace' New Construction Interior Improvement
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r�, 11 Air Conditioner , ` Install Piping _Processed
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"' ,i,-I`1,7 Air Exchanger: I. Gas Exterior HVAC Unit
III u,,1,t' i' , ;- "' _Heat Pump' • Under/Above round Tank (_Install/_Remove)
+i,I ,;�t �llNI <° Other , ?6 RI Wr 1>kr-i,ru.t
RESIDENTIAL FEES
$60.00 Minimum Add or alteration to an existing unit,includes State Surcharge
$100.00 Residential New,includes State Siurchargk _$ TOTAL FEE
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COMMERCIAL FEES
Contract Value$ 4 TSG 6 x.01
$60.00 Permit Fee Minimum `
$75.00 Underground tank installation/removal,includes State Surcharge =$ tnc, Permit Fee
4; _6 3� 2,11 rcarge
Surcharge=Contract Value x$0.0005 "'N• .� •
If the project valuation Is over$1 million,please call for Surcharge =$ (Q� •. •�17 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 niy an application for a permit,end work Is not to thout a permit;that the work will be in accordance
with the approved plan in the case of work whiclrlulres a review and approval of plans.
s_brAA. 14 -.e4-ee'- .
Applicant's Printed Name App ant's Signature
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