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MECHAIVICAL (RESIDENTIAL)
~/OS Permit Application
W ~ ~ City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5694
Please complete foc Single Farnily Dwellings
Townhomes and Condos when perm~ts are required for each unit
Date f ~ / a°~ /
Site Address y`l e~5 5~~-~r~e- ~o; r~~ Unit #
Property Owner ~CS~ tr1 Telephone f~ (C.eSi )''-I SS
~'~p3~] ~
Contractor Wohlers Southside Htg. & Air, Inc.
5950 W. 146~' St., #106
Street Address Apple Valley, MN 55124 City
State (952) 431-7099
Telephone # ( )
The Applicant is ~ Owner ~ Connactor _ Other
Add-on, modificaUon or alteration to existing dwelling unit $ 30.00
~ furnace replacement
air exchanger
~ air conditioner
other
State Surcharge $ .50
Total ~ ~ ~ ~I~ ~ ~(~`~Z~--
I' ~ . ~ 3 , 07 L~~
I hereby apply for a Residential Meehanieal Pernvt and aclmowledge that 4 mformaUpn ic_ce~ng _ d accucate; that the work will
ba in confonnance with the ordinances and codes of the City of Eagan and~'the Mec~ianical Codes; that I understand this is not a
pernut, but only an application for a pernut, and work is not to start without a perxnit; that the work cvill be in accordance with the
approved plan in the case of work wluch requires a review and approval ofplans.
~'l 1 P t ~ ~.U_7 1 ~~Y' L V~-~ ~/Z lJ~ V'~-C.~
Applicant's Printed Name Applicant's Signature
MECHANICAL (COMMERCIAL)
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5694
Please complete for: commercial/indusfial butidings
multrfamily buildings when separate permits are not required for each dwe0ing uni[
Date / /
Site Address Unit #
Tenant Name (if applicable) Previous Tenant Name
Property Owner Telephone # ( )
Contractor
Street Address City
State Zip Telephone # ( )
The Applicant is _ Owner _ Contractor _ Other
Work Type
Newconstruction UndergroundTank _Install _Remove
Interior Improvement Call for inspection during installation/removal of tank
Processed Piping
Nature ofWork:
Permit Fee $50.50 Minimum Fee (includes State Surcharge)
Contract Value $ x 1% _ $ Permit Fee
. If permit fee is $1,D00 or less, add $.50 ~ $ State Surcharge
If permit fee is over $1~000, add $.SD per
$1,000 Permit Fee
$ Total Fee
I hereby apply for a Commercial Mechanical Permit and acknowledge that the information is complete and accurate; that the work
will be in conformance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; that I understand rhis 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.
Applicant's Prin[ed Name Applican['s Signature
Approved By: , Inspector Date:
t ,
SAN
Tt .
W $,-lliNeI, Irma Reed 1 RMr - NO.. '" 2 m
h MN 55i22 E:x W th . y a
_cn.ng x ' of iRt -- Y, ^i''!'+ i.}'.
: ... ... '
Site A ess: 2 ! iu :; .:._. 7,'1
- Pltenber
Mft r No.: Connection Charge: 1. - • • .. ,.
Size: _ - . DQposat:
'`R* der No.: Pit Fee: .
I agree is noAltiiti►. wttN 41 Cie of 160 r
Ordi�w ' 'Miac. Charges:
; ; �� ' ; �<� �` _
Total:
:
By Date POid:
e of . 1 4 insp.:
8�lS Met . �,.. L _. .. -. �. �. -P �
loam 14414 .� ! PERMIT DATE: . NQ t „
Z o n i n g :
Cdr, No. of Units: ,
Site :A�klress:
! MAC to eaelPir with tin Ow
•
Oribeeases.
Account Deposit:
Permit Fee:
Surcharge:
D ate of Mtrsp: Misc. Charges:
Total:
lnsp.: Date Paid:
f•
Use BLUE or BLACK Ink
r - - - - - - - - - - - - - - - - -
I For Office Use
In o
City of EaEd Permit#:
I Permit Fee: I
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 1 Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: `7 7491 U J5a O e V70-0'170V e l- Unit M
Name: Phone:
Resident/
Owner Address / City / Zip:
Applicant is: Owner Contractor
Description of work: ee ,P-J d fl
Type of Work
Construction Cost: D U Multi-Family Building: (Yes 3<~No )
Company: h6kxe- to Contact:]
Address: S4.e b'" Q- City: Kie-nS /dl e
Contractor
State: An Zip: C.5 3 3 / Phone: 4 (ep 47
License 22~ 3 1~7Q o~ -7 Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, 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 Call 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.gogherstateonecall.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 approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
X ed°--
Applicant's Printed flame ns aturiePage 1 of 3