4710 Markam PtRESIDENT OWNER
Name: 3 a h ¥V tit/ t 1 Phone: 5
Address City Zip: 4 1 0 t let VY'1 e
CONTRACTOR
Name: a ;ti';f1 o6e Aug; c -J /-r License teLa L/r
Address: 1_96 v /k?/Y//LL/r1r1.t 5r
City: //74 s7/4/73 State: AV Zip:35°
Phone: ‘57 I/ 3'2- 7/ -2 7 Contact Person:
TYPE OF WORK
New Replacement Additional Alteration Demolition
Description of work:
i1 OT B h roof a u I c h t i�� quipm c red o
be s reeved y Cit G d PI s tt e M� is ir"al Insp ct r t±
lan e Of t on on, per m!tted r scre err
PERMIT TYPE
RESIDENTIAL
Furnace
COMMERCIAL
New Construction Interior Improvement
Air Conditioner
Install Piping Processed
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) 0
out appliances, ductwork, etc.) (includes $.50 State Surcharge)
TOTAL FEE
$90.50 Fire repair (replace burned
COMMERCIAL FEES:
$70.50 Underground tank installation
$50.50 Minimum (includes
/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 Tess than $1,000,
If Permit Fee is $1,000, surcharge
State Surcharge
$1,000 Permit Fee (i.e. a $1,001-
TOTAL FEE
1 hereby acknowled a that this inf
Date:
Tenant:
Gityof Eaaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
9 ormat i s complete and a ccurate t hat the wor will be in con
I unders d this is not a permit, but only an application for a permit, and work is not to start with
pia th case of work whiires a rev& and approval of plans.
fl
!want's Printed Name
ance with the ordinanc s
2009 MECHANICAL PERM T APPLICATION
(3
11,1 mem
e
'9/70
Permit Fee:
Date Received: 0 0)1
Staff: Ci
Permit
-p+
Suite
nd codes of the City of Eagan; that
a permit; that the work i be in accor ance with the approved
CITY OF EAGAN• WATER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.•
Eagan, MN 55122 DATE:
Zoning: No. of Units:
Owner: — —
Address:
Site Address:
-
Plumber:
Meter No.: Connection Charge: —
Size: Account Deposit:
Reader No.:. Permit Fee:
agree to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges: -
Total:
By 1� h-114/ Date Paid: —
Date of Insp.: Insp.:
CITY OF EAGAN' SEWER SERVICE PERMIT
3795 Pilot Knob.Road PERMIT NO.•
Eagan, MN 55122 DATE:
Zoning: _ No. of Units:
Owner: —
—
Address:
Site Address: Plumber: —
1 agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
By Misc. Charges:
Date of Insp.• Total:
Insp.: —_— Date Paid: —