1730 Bluebill Dr ME91701RESIDENT OWNER
Name: ___N-A('S1 KA. s,._. Y 01 �L Phone: (f1 0 s9
Address City Zip: 1 6 k
CONTRACTOR
Name: License 5 11
RNSVILLE HEATING NC, INC.
Address: i i
City: Suite 120 State: Zip:
urnsville, MN 55337 �l
Phone"4S C \�i -af) Contact Person:
TYPE OF WORK
PERMIT TYPE
New x, Replacement Additional Alteration Demolition
Description of work: t j' C Du. t l Q9 L t. g
y TE:
c 5) 3 f> 9 J F
RESIDENTIAL
Furnace
Vuwr�B k "pg F �u G4 i i
S`�S k !k I Y i
COMMERCIAL
New Construction Interior Improvement
Install Piping Processed
Air Conditioner
Air Exchanger
Gas Exterior HVAC Unit
Heat Pump
Under Above ground Tank Install Remove)
Other
When installing/removing tank(s), call for inspection by Fire
Marshal and Plumbing Inspector
RESIDENTIAL FEES:
$50.50 Minimum Add -on
or alteration to an existing unit (includes $.50 State Surcharge)
out appliances, ductwork, etc.) (includes $.50 State Surcharge)
53, TOTAL FEE
$90.50 Fire repair (replace burned
COMMERCIAL FEES:
$70.50 Underground tank
$50.50 Minimum (includes
installation /removal OR
State Surcharge)
surcharge is $.50.
increases by $.50 for each
$2,000 Permit Fee requires a $1.00 surcharge).
Contract Value x 1%
Permit Fee
If Permit Fee is less than $1,000,
State Surcharge
If Permit Fee is $1,000, surcharge
$1,000 Permit Fee (i.e. a $1,001-
TOTAL FEE
City of Etall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
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Applicant's Printed Name
kJ-Kai
CEONIf
ti OCT 2 0 2009
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i
2009 MECHANICAL PERMIT APPLICATION
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Date: t\ Site Address: c) CN( l i2 1J
Tenant: 1 k Y V
Permit 7 0'
Permit Fee:
Date Received:
Staff:
Suite
I h ereby 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 case of work which requires a review and approval of plans.
AppUIcant's Signature