D102 For Office Use
R , , Permit#: /•-• 7 ó .c—
EAGAN
" ' E AGA N
(/ 7D
`` ir'� 0' Permit Fee:
Staff:
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 f ' �,r"'' Payment Recvd: Yes No
(651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-56 �r. I
Email: buildinainsaections( dtyofeagan.com R,h n I Plans: Electronic Paper
Plan Submittal:ealansCaacitvofeaaan.com `
t
2019 COMMERCIAL MECHANICAL PERMIT APPLICATION
❑ Please submit two(2)sets of paper plans with all commercial applications as well as an electronic set of the
submittal,submitted via email,CD or flash drive
Date: �0 / / Site Address: / Oh S S'it(.._- C-e-:,-61,1Z- 6---
Tenant: Suite#
rt) /0 -4_
, ..
Owns
Name: Phone:
Address/City/Zip:
c /71Name: A`Q G c e.-/5 kl'C2 License#:
zr Address: 3 F 5'2 le) 'h J he 5�‹Ii--' City:bioi, A a 4-c-Q..
State: /!A/1 Zip: ,s--- ---.3 7 a phone: c /„ —3' -3`r 3 'T
Contact: £ral �`Q a YI Email: ISP a h /1 Oa 'C',,lc? ® g"-ha/6
_New Replacement Additional Alteration Demolition
Type Description of work:
4 7y L , S"'.i`:
NOTE: • la ount F ��n I mired s�ned by.City
n .M
=e,
:,:',9,1.1,,:,:, b,�,.--'71 fact Mechai tl,in0forim�rrnation on,permitted min.»> thods.
i COMMERCIAL s'
' ' . ' ' ''":''':"' _X_New Construction Interior Improvement Cell 6; ✓id 11 v
Permit T _ Install Piping Processed l'
Gas Exterior HVAC Unit
—
Under/Above ground Tank (—Install/ Remove)
COMMERCIAL FEES ,/
Contract Value$3) `7 0 d x.015
$60.00 Permit Fee Minimum {.1
$75.00 Underground tank removal, includes State Surcharge =$ V V - 0 6-) Permit Fee
=$ / -7 Q Surcharge
Surcharge=Contract Value x$0.0005
If the project valuation is over$1 million, please call for Surcharge =$ 2/.- 0 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.citvofeastan.com/subscribe.
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 = •-rmit;that the work will be in accordance
with the approved plan in the case of work which requires a review and approval of plans.
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Ap licant's Printeame Ap licant's Signatu -
FOR OFF'iCEM3 Y 8 y tY rT g !
Required l • ''45fie
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z gh wjriw Q# Servic e T in-0cxx Heat �,�.''~ i l ,, - HVAC Screening