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2042 Safari Heights TrCity of Earn 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 r Use BLUE or BLACK Ink Permit#: (-7° Permit Fee: ` o- o� Date Received: Staff: 2010 RESIDENTIAL BUILDING PERMIT APPLICATION /0(07/0 Date: Site Address: 0� 0 ti Z S st-er442-i— (-E Fro/7, sl 2/4 I L- ccA-9a n r %Al iv Tenant: P 1 f 1- �C < 7T (0( '-3 : I 'ly i � �� ��� co ( v U�, vKi Suite#: RESIDENT / OWNER Name: Slc c- Tv- �� 2 PcT2_ Phone: (owl ^ 2-6 /- cga./ Address / City / Zip: e204 2-1464(...Tiiirr6F775 Tlei41L Applicant is: +Owner Contractor & ot-ru + v14 A) S-/2 Z TYPE OF WORK A Description of work: g06 -r g do — (-ham I ( O« I Construction Cost: %1 (.' i DOC) Multi -Family Building: (Yes /6Vopf ) CONTRACTOR /1/4_ v Name: License #: Address: City: State: Zip: Phone: Contact: Email: COMPLETE In the last 12 months, has Yes No If yes, THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING / — the City of Eagan issued a permit for a similar plan based on a master plan? UV date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: NOTE: Plans and supporting documents that you submit are considered to be public information Portions of' the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets. , , CALL BEFORE YOU DIG. Call Gopher State One CaII at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.qopherstateonecall.org 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 a roved plan in the case of work which requires a review and approval of plans. cc- v) 17tr2..R-t -- Applicant's Printed Name x App atur Page 1 of 3 - = INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55122-1897 Date Issued: (612) 681-4675 SITE ADDRESS: a r tc 1t f. Y (1 If 1 1'?1 V R SAFARI F%)Atkti `NO PERMIT SUBTYPE: APPLICANT: 1,61 , ,,, i 014,1 (bl?ll Cle-91/0 TYPE OF WORK: fit'u INSPECTION TYPE .DATE INSPTR INSPECTION TYPE DATE INSPTR. . !a I Nir I'I,If) ? r?' P! !I 1 i. REMARKSa SfAW 1`11 t.1MBFR F L 7 I E Permit No. Penult Holder Date Telephone tt ELECTRIC glf( ?? (p i3 PLUMBIN HVAC 4 5 ?? Inspection Date Inap. Comments FOOTINGS (.Z( A7 FOUND 7'9-117 Mg FRAMING ROOFING ROUGH PLUMBING l / [ ! PLBG AIR TEST ROUGH HEATING GAS SVC TEST 7 INSUL / GYP BOARD FIREPLACE S/ r C FIRE AIRS ESTCE J / ? / FINAL PLBG ? FINAL HTG V SAT TE TEST BLDG FINAL 47 7! BSMT R.I. BSMT FINAL DECK FTG DECK FINAL a4% wtmf icate of ccc"auc? With of Wagan -mot of Sam"% an"ection This Certificate issued pursuant to the requirements of the Uniform Building Code certifying that at the time of issuance this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following: Use Qassificatioe: SF DWG/GAB Bldg. Permit No. 30298 o.w.,?rya R3 U-1 Zimirrgam;« R-1 Type Cow. Vn OwwotBuddi% RATZLAFF CONST Address 14551 COUNTY RD 11, BURNSVILLE Brewing Addn= 2042 SAFARI HTS TR L-auh L22, B1, SAFARI ESTATES 2ND Doe: /Ulq A, ,J Brame Off'rod POST IN A CONSPICUOUS PLACE Address 2042 SAFARI HEIGHTS TR Lot 22 Blk 1 Sub SAFARI ESTATES 2ND Zip 5512 2 THESE ITEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECTION. Date: /0/9/9 Yes No Inspector: 60, Final grade (6" from siding) ? Permanent steps (garage) V, Permanent steps (main entry) ? Permanent driveway r/ Permanent gas Sod/Seeded grass pf Trail/curb damage Porch V Basement finish Deck I? Please verify with the builder the removal of roof test caps from the plumbing system and the shut-off of water supply to the outside lawn faucet before freeze potential exists. Contact engineering division at 681-4645 before working in right-of-way or installing underground sprinkler system. White - City Copy Yellow - Resident Copy Pink - Contractor Copy G _ OFFICE USE ONLY This request void IB months from validation dare printed in this box. IIIIIIIII I III I III III IIII II II I III I III ??Ik?-?, ? ? aN??? (s?aC * 0 4 8 4 9 2 8 7* PLEASE PRINT OR TYPE ls 7 V 4010 Rat°? Oare Roughin impaction required? es 0 No I Inspection Other Than Rou Wn: D Ready NavANill Call ?'? (Voa mun call the inspe for when ready) Done Ready: I, licensed contractor 0 owner hereby request inspection of the above electrical work at: /0x- lob Md., (Street, B., or Rwh No.l City Zip Code Section No. Townshio Name or No. !?-- W. Fire N„ ea,m. Power»SUpplier J? / Address Elechiml omroctor ICompony Namel /t i Z a h/?oJ`l Nwiling Address ICmhador or Ow Performing Installation) ;P6 Z'xo? e'a ,QV = 4 `? ?. 32-s77 a Ph.. Na. '7 zl°y-/ /7 UH T1ONS ON MCK OF YELLOW COPV 484=928 61,A 8/97 REQUEST FOR ELECTRICAL INSPECTION 175j; MinnesoM State Board of Electricity 1821 University Ave., Rm. S-128, St. Paul, MN 55104 Phone (612) 642-0800 Home Du lex t. Bldg. Other: 6LIT New Addn Commercial Industrial Farm Remod Repair Air Cond. Htg. Equip- Water Htr. Load Mgmt. Other: Dryer Range Elec. Heat Temp. Service "X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only. Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee: Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Mobile Home Park Stall 0 to 200 Amps sy to 100 Amps 7 .4-p Street Ltg./Traffic Sig. Above 200_Am s Above 100 Amps Transformer/Generator INSPECTOR'S USE ONLY a' TOTAL - Sign/Oufline Ltg. Xfmr. ^^ 1 s - j j Alarm/Remote Control z e- Cj / So w - ?- 4T?`' - m Swimming Pool ? ' i r! CYi tQ/v?i', bFra rbed F1Gi wA I IIBf2b VIII IFgI I i@S III@ @ ac L IIISIU IpM1011 dBSRIb I,eRlll on th@ dm@5 5101@' Irrigation Boom RougMn Date S ecial Ins ectan p p Investigative Fee Final Dale o THIS INSTALLATION MAYBE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. PERMIT CITY1 OF EAGAN 3830 Pilot Knob Road PERMIT TYPE: 8 U 11-DING Eagan, Minnesota 55122-1897 Permit Number: 0 3 0 2 9 9 (612) 681-4675 Date Issued: 06/25/97 SITE ADDRESS: 2042 SAFARI HEIGHTS TR LOT: 22 BLOCK: I SAFARI ESTATES 2ND DESCRIPTION: i.t,$1dk€t VPermit Tyne SF OWO u, iflg err. Type NEW 3otrr R-3 U-1 ' 'ce,n?-t°u'G'C'ictt'F VN R-1 ??Sl?atlg ???gu? €? G4 h! - 44 fit s F t 1 , 910 LEA 1c 101 1 - FAN. DETACH 01 REMARKS: S & W PLUNGER == yyl ?,c.,r- ,r-r-?QO FEE SUMMARY: VALUATION Base Fee Plan Review Surcharge SAC SAC 9. SAC Units Subtotal $1,242.25 $807.46 $85.50 $950.00 100 $3,025.21 $171,000 NISC FEES -. E1, 539.50 Total Fee $4,624.71 CONTRACTOR: -- Applicant - ST. Lic. OWNER: RAW LAFF CONST 1.4329770 0002995 RATZLAFF CONSTRUCTION 14551 COUNTY ROAD 11 14551 COUNTY RD 11 BURNSVILLE NN 55337 BURNSVILLE NN 55337 (52) 432-9770 (612)432-9770 lieretSy cktSCvxl fit ti# that ' , hav" ` re ?£ W 1Ta 3 ?A66xt aA ?t ei.t .1 ht t bo " faun a c r s r recd °€t 0#4e' tc? s tltht ald z b e t r+ Y x x1a APP' / E SI A URE ISSUED : SIG TURE Vv CITY of i_AC:a N CASHIER: S TERMINAL NO 57 BATF..a 06/25/37 TIME: W006 ID'". NAME, ! ATZLAFF" CONSTRUCTION IN(, 2256 3001 2042 SAFARI HTS 4,624.71 Total Receipt, Amount; 4v624.71. CRO 7 15898 USER IDc NANCY • t , 1997 BUILDING ?) © Name: Ir?„RaclT a Phone #: ?2 Zg!"t ? 3 registered site surveys s 2 copies of plan • 2 copies of plans (include beam & window sizes; poured find. design; eta) ? 2 site surveys (extedor additions & decim) • 1 energy calculations ? 1 energy calculations for heated additions ? 3 copies of tree preservation plan if lot platted after 7/1/93 required: _ Yes _ No " DATE: CONSTRUCTION COST: DESCRIPTION OF WORK: / C&y,: `/ q'. STREET ADDRESS: 2042 `ma'r AM VO-r'5' r?q,U L-e{ *, BLOCK SUBD./P.I.D.#: ?APAPJ ke516'TEA5 I PROPERTY OWNER CONTRACTOR Street City: State:, Zip: Company: PjMl_ Aa 16100S?? Phone* ?/ q D Street Address: Vl%i, .v, r4.,%f• License #: v ¦ / S City: it1SV(i L.G7 State: Zip: - PERMIT APPLICATION (RESIDENTIAL)? CITY OF EAGAN 3830 PILOT KNOB RD - 53122 f?.Lo 681875 Remodel/Repair Recuirennents ARCHITECT/ Company: ENGINEER Name: Phone #: Registration M Street Address: City: State: Zip: Sewer & water licensed plumber (new construction only): Ci1Clk? j&Tjkkq Penalty applies when address change and lot change are requested once permit is issued. I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant OFFICE USE ONLY RECEIVE Certficatesof Survey Received 4- Yes _ No JUN 19 1997 Tree-Preservation Plan Received Yes No Not Required BY__ OFFICE USE ONLY BUILDING PERMIT TYPE 0 01 Foundation ? 06 Duplex ? 11 Apt./Lodging ? 16 Basement Finish 02 SF Dwelling ? 07 4-plex ? 12 Multi Repair/Rem. ? 17 Swim Pool ? 03 SF Addition ? 08 8-plex ? 13 Garage/Accessory ? 20 Public Facility ? 04 SF Porch ? 09 12-plex ? 14 Fireplace ? 21 Miscellaneous ? 05 SF Misc. ? 10 - plex ? 15 Deck WORK TYPE 31 New ? 33 Alterations ? 36 Move ? 32 Addition ? 34 Repair ? 37 Demolition GENERAL INFORMATION Const. (Actual) VO _ Basement sq. ft. MC/WS System (Allowable) Main level sq. ft. City Water UBC Occupancy 3 i sq. ft. Fire Sprinklered Zoning sq. ft. PRV # of Stories Z- sq, ft. Booster Pump Length RE sq. ft. Census Code. 101 Depth Footprint sq. ft. SAC Code 01 Census Bldg 1 Census Unit f APPROVALS Planning Building FM Engineering Variance Permit Fee Valuation: $ 01, 000• Q7 Surcharge Plan Review ?gME1Jr CUcl?t sh-EA?; License MC/WS SAC --- - --- - , - } ??`} x I y% ZOO ?j(p0 , dJ City SAC Water Conn. Water Meter 12? qlj © O.DO 10 / Acct. Deposit S/W Permit S/W Surcharged E •. Treatment PI. 2 y SS Road Unit Park Ded. Trails Ded. Other PoRu+. Copies Total: f? X62 % SAC' SAC Units ?tuf1( l } 1008.00 Certificate of House Location For: 1`jUlaff Construction, Inc. r•111Ya.? Lot Address: 2042 Safari Heights Trail DELMAR H. SCHWANZ LAND SURVEYORS, INC. R"' UnM, La" of TM St.t. 6l Mlnn..ot. 14750 SOUTH ROBERT TRAIL ROSEMO 'N MINNESOTA 55088 Proposed garage floor elev. SURVEYO ERTIFICATE Proposed top of block elev. Proposed lowest level elev. (¢ ?? <j / o_2Z2 ti\ 5e, 53 o ?9 _--IL/ W W h,D P ?9S o . / 19 o ar o r z ?b ?ZYan•? ? . G? N ?Pq?81 / o °o BLo?K N y 0 55'4 Drainage & Utility b Easements 2 1,:AGANI E';2?I1dE R11V /MTT. Description: Lot 22, Block 2, SAFARI ESTATES SBCOND ADDITION, according to the recorded plat thereof, Dakota County, Minnesota. Also I hereby certify that this survey, plan, or report was prep=.red by me or under my direct supervision s-d that 1 an. a duly Registered Land Surveyor under the laws Of tTt state of Minnesota. Dated 06-17-97 / `f0 /// C-) H9757 612/423.1789 Scale: 1 inch = 30 ft = Iron pipe monument ? = Set wood hub at building offset \,.o x ygl= Spot elevation O = Proposed elev. \ Proposed direction of drainage N f z/ \ qg v??4Py 4b k8 DELMAR H. SCHWANZ ` _ -8625- 20" Delmar H. Schwan minnows Registration No. 882S of a proposed house staked thereon. • LOT SURVEY CHECKLIST FOR RESIDENTIAL LDING PERMIT APPUCAT19N PROPERTY LEGAL: DATE OF SUIR?W LATEST REVISION: 6 DOCUMENT STANDARDS [? ? • Registered Land Surveyor signature and company ? • Building Permit Applicant 9"?? ? • Legaldescription e'-'r ? . Address ? North arrow and scale ? ? House type (rambler, walkout, split w/o, split entry, lookout, etc.) 1 ? • Directional drainage arrows with slope/gradient % J ? • Proposed/existing sewer and water services & invert elevation f ? • Street name ? ? • Driveway ELEVATIONS Existina O'?O ? • Sewer service (or Proposed) B"?? ' ? • Property comers ff-? E ? Top of curb at the driveway ?/? ? • Elevations of any existing adjacent homes Proposed ? ? • Garage floor 13'? ? • First floor ZJ' ? O Lowest exposed elevation (walkout/window) /a' ? ? • Property comers ?? ? Front and rear of home at the foundation PONDING AREA (if aooliicable) "? ? Qr ? • Easement line ? E;,,- ? NWL ? 9- ? HWL ? ?J' ? • Pond # designation ? Emergency Overflow Elevation DIMENSIONS / 10 ? . • Lot IinesBearings & dimensions /zr' ? ? Right-of-way and street width (to back of curb) ?--l'? ? • Proposed home dimensions including any proposed decks, overhangs greater than 7, porches, etc. (i.e. all structures requiring permanent footings) lir-'c ? • Show all easements of record and any City utifities within those easements 1w, ? ? • Setbacks of proposed structure and sideyaryl setback of adjacent existing structures - / ? l? ? • Retaining wall requiremen"any Reviewed: - ' \' / / Date January 1995 CWM1.WGLDWRMr.FM ------ ----- - --- --- RESIDENTIAL "COOKBOOK " METHOD --------------------- ------------ - SITE ADDRESS -- ----- 2042 Safari Heights ------------ Trail City - ------------ ------- Eagan ------------ ------------ BUILDER ------ --------- Ratzlaff ----------- Constructio -- - n Inc. Date 6/18/97 ------------- ------ 14551 Co --------- . Rd. 11 Bu ----------- rnsville, MN 55337 ---------------------- ------------ WINDOW AREA (S.F.) WINDOW AND DOOR AREA AS A PERCENT Dimension ------------ -- --- Otv. -------- Area ---------- OF WALL AREA --------------------- ------------ 2.50 - 4.00 15.00 150.00 2.00 5.00 5.00 50.00 2.50 5.00 5.00 62.50 373 / 3,079 X100 = 12.1% 2.00 5.00 1.00 10.00 2.00 3.00 2.00 12.00 5.00 5.00 1.00 25.00 0.00 DESIGN FEATURES 0.00 0.00 Assembly Type ------------ DOOR AREA (S ------ .F.) -------- ---------- Framing Standard Dimension Qty. Area ------------ ------ -------- ---------- Cavity insulation (R) 19.00 3.00 7.00 3.00 63.00 0.00 Wall sheathing (R) > R-5 0.00 ------------ ------ -------- ---------- Window U-Factors 0.48 TOTAL AREA Windows and Doors 372.50 ------------------------------------ ------------------------------------ WALL AREA (S.F.) Wall Perimeter Height Area --------------------------------- --------------------------------- Maximum percent window and door area per design options. 172 10.00 1,720 151 9.00 1,359 0 0 Allowable amount 13.5% Actual amount 12.1% Actual percent must be less than -----------------------------------= maximum allowed TOTAL AREA Walls 3,079 Checked By L aZ BL CITY USE ONLY nit SUBD. RECEIPT #: 91J?15 RECEIPT DATE: 1998 PLUMBING PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612) 681-4675 Please complete for: ? single family dwellings ? townhomes and condos when permits are required for each unit ? backflow, ppreventer for underground sprinkler system ------------------°' '---------- FIXTURES - - EACH # TOTAL Shower 3.00 x = Water Closet 3.00 x = Bath Tub 3.00 x = Lavatory 3.00 x = Kitchen Sink 3.00 x = Laundry Tray 3.00 x = Hot Tub/Spa 3.00 x = Water Heater 3.00 x = Floor Drain 3.00 x = Gas Piping Outlet ' minimum -1 3.00 x = Rough Openings 1.50 x = Water Softener ' for dwellings under construction 5.00 x = Water Softener ' for existing dwelling 20.00 x = U.G. Sprinkler ' for dwelling under cont 3.00 U.G. Sprinkler ' for existing dwelling 20.00 = ao? Alterations. ' to existing residence 20.00 = Water Turn Around 20.00 = Private Disposal System ' MPC lic. 75.00 = (new and refurbished systems) Private Disposal Systems' Abandonment 20.00 = STATE SURCHARGE .50 TOTAL 22?5? ---- --------------------------------------------------------------------------------------------------------------------------------------- Ihereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable City of Eagan ordinances- It is the applicant's responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by the City during its normal operational and mairltWance activities to the facilities construyt}d ungo jhf p,permit within City property/right-of-way/easement. SITE ADDRESS: OWNER NAME: lot INSTALLER NAME:/ ?liAY {?n_ iw? TELEPHONE #: /,3 - IS O STREETADDRESS: 6 6u U a CITY: ? STATE: /V n ZIP: 720-IP SIGNATURE OF PERMITTEE JWORMS BLDG/PLBG PERMIT (RESIDE IAL) 1998 L c> ? BL / SUBD. ?HG7 1996 PLUMBING PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612) 681-4675 SITE 5506 OWNER NAME: & zzaA &1151rue_?/-.'on INSTALLER NAME: 141?he-LD -Zaniels, Lji a . STREET CITY: i?ysemailn? STATE: /?/A/ ZIP: S?o?X PHONE #: (6/2,) 40- 3736 w SK3NALURE Please complete for: ? single family dwellings RECEIPT #: _LL I' DATE: (P °x"/97 ? townhomes and condos when permits are required for each unit FIXTURES EACH ?4. TOTAL Shower 3.00 x i = 3.00 Water Closet 3.00 x 9-06 Bath Tub 3.00 x 2 = &.40 Lavatory 3.00 x _ .oa Kitchen Sink 3.00 3.04 Laundry Tray 3.00 Hot Tub/Spa 3.00 ;c = Water Heater 3.00 x 3.46 Floor Drain 3.00 x 3.00 Gas Piping Outlet * minimum -1 3.00 x 3.00 Rough Openings 1.50 x -6 = .so Water Softener 5.00 x 1_ = S.oo Private Disposal * Dakota Cty. license 65.00 = (new and refurbished systems) U.G. Sprinkler * home under const. 3.00 = Alterations * to existing 20.00 = Water Turn Around 20.00 STATE SURCHARGE .50 TOTAL CITY USE ONLY OFFICE USE ONLY L BL SUBD. RECEIPT #: DATE- 1996 PLUMBING PERMIT (COMMERCIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612) 681-4675 - Please complete for: * all commercialtindustrial buildings. multi-family buildings when separate permits are = required for each dwelling unit. DATE: CONTRACT PRICE: WORK TYPE: NEW CONSTRUCTION ADD ON REPAIR DESCRIPTION OF WORK: IS WATER METER REQUIRED? - YES - NO. IF SO, PLEASE PROVIDE THE FOLLOWING: WATER FLOW: GPM. ARE FLUSHOMETERS TO BE INSTALLED? _ YES _ NO. FAILURE TO PROVIDE THIS INFORMATION WILL RESULT IN A DELAY OF METER ISSUANCE. WILL YOU BE INSTALLING A METER FOR A FUTURE U.G. SPRINKLER SYSTEM? _ YES _ NO. IF SO, YOU MUST APPLY FOR A SEPARATE U.G. SPRINKLER PERMIT. FEE: $25.00 minimum fee or 1% of contract price, whichever is greater. State surcharge of $.50 per $1,000 of permit fee due on all permits. CONTRACT PRICE x 1% STATE SURCHARGE TOTAL SITE ADDRESS: TENANT NAME: OWNER NAME: INSTALLER: _ ADDRESS: _ CITY: PHONE #: SIGNATURE: OFFICE USE ONLY METER SIZE: DATE: STE. # STATE: ZIP: APPLICANT _ INSPECTOR: ?' CITY USE ONLY LOT P_2 BL RECEIPT #: 11715 91 L/P SUBD. pC RECEIPT DATE: 0/a5/f 7 1997 MECHANICAL PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN MN 55122 (612) 681-4675 Date: Complete this section only if You are installing HVAC in single family, townhome, or condos that are under construction and are not owner /occupied. • HVAC: 0-100 M B T U ADDITIONAL 50 M BTU • Gas outlets (minimum of one required @ $3.00 ea.) • State Surcharge: • TOTAL: .50 Ya. S-6 Complete this section only if you are remodeling, adding to, or repairing existing single family dwellings, townhomes, or condos. Add-on furnace Add on air conditioning Add-on air exchanger, i.e. Vance system, etc. Other N/iinimum fee applies to all remodel or add-ons of existing residences $ 20.00 State Surcharge .50 Total: $ 20.50 SITE ADDRESS: OVINERNAME: /C 5-/ PHONE !F 720 #: INSTALLERNAME: PHONE STREET ADDRESS: CITY: ?h STATE: ZIP: 5Sd.26 SIGNATURE F PERMITTEE $ 24.00 6.00 0' CITY USE ONLY L _, BL SUBD. RECEIPT#: RECEIPT DATE: 1997 MECHANICAL PERMIT (COMMERCIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612) 681-4675 Please complete for. DATE: ? all commercial/industrial buildings. ? muWamily buildings when separate permits are ngi required for each dwelling unit CONTRACT PRICE: WORK TYPE: NEW CONSTRUCTION INTERIOR IMPROVEMENT DESCRIPTION OF WORK: FEES: ? $25.00 minimum fee p_r 1% of contract price, whichever is greater. Processed piping - $25.00 ? State surcharge of $.50 per $1,000 of pit fee due on all permits. CONTRACT PRICE X 1% PROCESSED PIPING STATE SURCHARGE TOTAL SITE ADDRESS: OWNER NAME: TELEPHONE A TENANT NAME: (impRovEmENTs oNLY) INSTALLER: ADDRESS: CITY: PHONE #: STATE: ZIP: SIGNATURE: SIGNATURE OF PERMITTEE CITY INSPECTOR