1530 Thomas Lake Pt - Unit 302 Use BLUE or BLACK Ink
For Oflla�/(!/0�l!
City of Ekon Permit :
3630 Phot Knob Road Permit Fee: / 0
Eagan MN 55122 /�
Phone:(651)575.5675 Date Received:
L Stall:
2017 MECHANICAL PERMIT APPLICATION
0 Please submit two(2)sets of plans with all commercial applications.
Date: /0— Y-1/ Site Address: /S-71)--3 O Z
Tenant: r g edit&I LA41:4 Suits#: /S-3 -302
RtlfslderitlOwi»r Name: N =�O- 10).1 LSa-e- fi d 3-N/ ,PPhone: teS 7`' $rr—'�3 9
Address/City/Zip: /Sb O 't&4 PY OJ �o"4 k. r`ed CCPWS I L Z„
Name: W 1 15 O a a Vb 4 G l ov4l License 0: Ali")
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Contractor
Address: t S-7-41r Le I/7 IL' 34 , City: B e r—
stats:WI r Zip:was-2 09 Phone: 7 67 ?• —rt 9�
Contact KW IAA L G/ Email:L01/504 G O O •Cthn..
New iVReplacernent Additional Alteration Demolition
Type of Work Description of work: Ref 4, #td►M4a-12-e-- 4-041
NOTE:Roof mounted and ground'Mdpftsd'nleChahanittal pulpment Is regUired to be screened by City
Code. Please contact the Mechitii)o t'i'ffiS$ator for Infonn itlon on permitted swooning Methods.
RESIDENTIAL COMMERCIAL
✓'Fumece New Construction _Interior Improvement
l�
Permit Air Conditioner Install Piping P, ooceseed
ype
Air Exchanger T Gas _Exterior HVAC Unit
_Heat Pump _Under/Above ground Tank install/_Remove)
Other
RESIDENTIAL FEES
$60.00 Minimum Add or alteration to an existing unit,includes State Surcharge
$100.00 Residential New,Includes State Surcharge =$ l 0 e0 TOTAL FEE
COMMERCIAL FEES
Contract Value$ x.01
$60.00 Permit Fee MInimum
$75.00 Underground tank installation/removal,Includes State Surcharge =$ Permit Fee
Surcharge=Contract Value x 50.0005 =$ Surcharge
If the project valuation is over$1 million,please call for Surcharge $ TOTAL FEE
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webelts at www.citvpfeaaan.comlaubscribe.
I hereby acknowledge that this Information Is complete end accurate;that the work will be In conformance with the ordinances and codes of the City of
Eagan;that I understand this Is note permit,but only an 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 plane.
x 1/SOa x -24.€4•1/2•222(1/
Applicant's Printed Name Applicant's Signature
FOR OFFICE USE
Required Inspections: Reviewed'By Duty
und.rground Rough in Air Test. ass 6sivide Tsw `in floor Haat Final ,,,HVAC Screening,