1520 Thomas Lake Pt - Unit 110 Use BLUE or BLACK Ink LA
For Office UseP nit � ✓
* 1 / r
City of Ea l �. o
3030 Pilot Knob Road " I CC--
Eagan MN minPhone:(661)675.5676 Date Received:
L
Stet
2017 MECHANICAL PERMIT APPLICATION
❑ Please submit two(2)sets of plans with all commercial papplications.
Dab: 1 d' ("l� Bib SZ.
Address; / - '"'!10 �il/4 I t
Tenant: ? IC.t°N+0 L' Suite 6: /524--/ l O
ResidenVOwner
Name: /UOOFtL,J I hfo,G S;i4:5 Phone:(S`�.-771r—S�?6 9
Address/City/Zlp: !r O TINAY+os' e-0-4(C Tot L1+e I W. a D010V 63—Mt
Name: t d is as N144 c. eoa urns y License*: >gi
Contractor
Address: rCIS tl�rt� V Citi: 13 c_cls cI r6 - '"(
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State: netA)
Zip:s"1"3 a8 Phone: //7,63-26 t�-5-/?b
Contact Ke :6'73-01%) Emelt �l W €1 k cAo o.Leo,
New �Replacamant Additional Alteration Demdltlon
Type of Work Description of work: (-e, -CA"'10 t— &' 4/C.-
NOTE:
GNOTE:Roof mounted end ground mounted mechanical equipment is required to be screened by City
Code. Please contact the Mechanical Inspector for information on permitted screening methods.
RESIDENTIAL COMMERCIAL
V Fymaoe New Construction Interior Improvement
Ail Conditioner _
Instal Piping roceeaed
Penult Type _Air Exchanger Gas Exterior HVAC Unit
_Heat Pump _Under/Above ground Tank ( Install I Remove)
Other.,
RESIDENTIAL FEES
$60.00 Minimum Add or alteration to an existing unit,Inductee State Surcharge
$100.00 Residential New,Includes State Surcharge =$ 66.0 G TOTAL FEE
COMMERCIAL.FEES
Contact Value$ x.01
$60.00 permit Fee Minimum
$75.00 Underground tank Installatlonlremotral,inductee State Surcharge =$ Penult Fee
surcharge=Contract Value x$0.0005 =$ Surcharge
If the project valuation Is over$1 million,please call for Surcharge $ TOTAL FEE
You may subscribe to receive en electronic notification from the City at proposed ordinances by signing up for an email update on the City's
cobalt*at www.cltvofiisan.comteubeorlbt.
I hereby acknowledge that this Information Is complete and accurate;that the worik 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,end 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 end approval of plane.
x /4< 4;4-ext L. Ai; is a x
Applicant's Printed Nam. Applicant's Signature
FOR OFFICE USE
Required Inspections: Reviewed By: Date:
Underground Rough in Alr Test Gas Service Test In-floor Heat Final HVAC Screening