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1540 Thomas Lake Pt - Unit 110
Use BLUE or BLACK Ink r For Office us/s� / �i *City f Permit 0: /`/ 0g(3 of Eapa Permit Fee: 31130 Pilot Knob Road Eagan MN 55122 Phone:(651)6754675_ Date Received: FAN. 4s-/-Or- 6 9`1 2017 MECHANICAL PERMIT APPLICATION ❑ Please submit two(2)sets of plans with all commercial applications. Date: !O--Y t? Site Address; /SVC —i/o 1:4-14' i Tenant: ? #<C'14//0..1 (.A 1'}• Suits 5:/5"C/4 I/6 R�sldsnf/Ownw Name: /v�lbl )tit e, /l?Ql 1/') Phone:t�S`�VES f36 9 Address/City/tip: /svo Itcrrioa Por wt e-- / op/ i^40,)S` 7 7.2- Name: W 1.&t1A tkV/C/ `Ca'" 003y License gill Contractor Address: C . tl/? L Si. Cly: 13�e..e e..- state:ret"J zip. 308 Phone: .763— I •-"S-G9. Contact: KW W i ZS ad Email: fL) G'' O a kt6 0-C.e ": — 0 0•C.OW% New VReplacement Additional Alteration Demolition — Type of Work Description of work: gef 1..[.LC.P_41.).rv.)4C.e- ‘''A C- NOT!:Roof mounted,and ground ii hhit tliri'lt nlcal egtilpmsnt is required tete soreinedby;Hy• Coda. Please Contact the Mechi ' 'inI dotor for lrifOrM Mtlon;on permitted milted ssrS$nino tiwt ods. • RESIDENTIAL COMMERCIAL • ✓'Fumace New Construction _Interior Improvement 1.41rPermit'Typo ir Conditioner —Install Piping _/Processed Air Exchanger Gas 'V....Exterior HVAC Unit Hest Pump —Under/Above ground Tank (_install!—Remove) Other RESIDENTIAL FEES $60.00 ll on Add or alteration to an existing unit,includes State Surcharge / $100.00 Residential New,Includes State Surcharge =$ t'D °' ©v 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$0.0005 =$ _ Surcharge If the project valuation Is over$1 million,please call for Surcharge e$ TOTAL FEE You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's website at www,cltvofeaaan.com/subecilbe. 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 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 plans. X / w VIA, (X)//t5Or) X6.)— i Applicant's Printed Name Applicant's Signature FOR OFFICE USE • Required Inspections: Rsvrawrr►�d ff:• oat* , Underground Rough In Air Test Gas Sir deTt161 "''" In-Hater H$at .'final ,HVAC Sifibhlnp