1530 Thomas Lake Pt - Unit 103 Use BLUE or BLACK Ink
For Orrice Use
Permit#: /
City of Eap,au Permit Fee: oo 0 of
9830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone:(551)67541175
L Staff:
2017 MECHANICAL PERMIT APPLICATION
❑ Please submit two(2)sets of plans with all commercial applications
Date: fo &/ 7 Site Address: / 57 G lUri
.i�
Tenant: a--1 t ►.+ suite 8: f 377
Resident/Or/norName:Na.47ah,ttJ e- 14:104- 11 Phone: /'' 8r$�'g367
rda Tl a,r..as !�-k e. Pe hot& Act•
Address/City/zip: /S3 0- l 0 3 i E6(3 m.a
Name: CV/ 1SOr1 MIA G Ca vtn,PetnS y License*: / /19
ContractorAddress: /SL g 1/7t S4 City:
State: mV.) zip:SS's de Phone: 7g 3 -r;6 e— SG 9 6
Contact Ke.,.4 60;75 d'- Email: GJ 440/.1 kV040GleOJ.o o .(*,�
New ✓Replacement Additional Alteration Demolition
Typo of Work Description of work: Ve A/L
NOW:Roof mounted and ground,rne,mmni dnieohsbioal equipment Is required to be screenedby City
Code. Please contact the Meehll&C' inspeetoi for Information on permitted scresnin.methods.
RESIDENTIAL COMMERCIAL
iL Furnace _New Construction Interior Improvement
JAlr Conditioner _Install Piping Processed
Pernik Type
Air Exchanger Gas 1/Exterior HVAC Unit
Heat Pump _Under/Above ground Tank ( _Install/_Remove)
Other
RESIDENTIAL FEES
$80.00 minimum Add or alteration to an existing unit,includes State Surcharge
$100.00 Residential New,Includes State Surcharge =$ tad.00 TOTAL FEE
COMMERCIAL.FEES Contract Value$ x.01
$80.00 Pprmlt Fee Minimum
575.00 Underground tank installation/removal,includes State Surcharge =$ Permit Fee
Surcharge=Contract Value x$0,0006 =$ 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 of proposed ordinances by signing up for an email update on the City's
website at www.ckvofeaaan.cam/subacrlbq.
I hereby acknowledge that this Information Is complete end accurate;that the work will be In conformance with the ordinances end codes of the City of
Eagan;that I understand this Is not a permit,but only en 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 pians.
x �.r•�r►•e. T: f(.tJ;is d,J 7:71.44‘414)
Applicant's Printed Name Applicant's Signature
FOR OFFICE USE
•
Required Inspections: •Rvlswedi®yt:. •
Underground Rough in �„„�Air Teet Ope SerV ce Tell) �„ lrl lo(of.Hpet. Final • ,P0i.it Screening