4612 1_2 Ridge Cliffe DrRESIDENT / OWNER
t "(l I' / I U� C Phone: 6J ^l - e r / 7 ? 0
Name: b 4 V' t
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Address / City /Zip: 7 -I ,C l & /�i lX j. (Y ✓ E4_,-1- __57.5 2_
CONTRACTOR
Name: ' ( `"` T H v4 C License #: B d - q3 - 5 C720
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Address: ! ` /4` els Az-, City: O I U a ' 1
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State: M s ` Zip: SS d / Phone: rP J /— °Z 3 J — 7
Contact: l ` 5 Email �t / fN cf
7 �a �n ' 61447 4 C4 � �k k
TYPE OF WORK
New Rep acement Additional Alteration Demolition
Description of work: t ACt , ✓' Ai c
NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by Ci
Code. Please contact the Mechanical Inspector for information on permitted screening methods.
PERMIT TYPE
RESIDENTIAL
.X
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
burned out appliances, ductwork, etc.) (includes
$.50 State Surcharge)
$.50 State Surcharge) $ TOTAL FEE
$90.50 Fire repair (replace
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,
= $ Surcharge
- If Permit Fee is > $1,000, surcharge
$1,000 Permit Fee (i.e. a $1,001
= $ TOTAL FEE
Cityofaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
2010 MECHANICAL PE MITAPPLIC TION c
Date: / z- Address: ( 7 / 6 1,2 V)--- h ( ' 64) Site Addr (/ / � G _. `1 S S 7
f � y
Tenant: Suite #:
x 1'w Z�1. - S
Applicant's Printed Name
x
Applicant's SignEture
Permit #: 7,2 7,g
3
Permit Fee: 5(1 6
Date Received: `6
Staff:
Use BLUE or BLACK Ink
-J
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.gopherstateonecall.orq
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 withouj,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.
Reviewe By
"Rough In _ Air Test ' Gas Service Te
_ Exterior HVAC Screening Inspection
Hea
FOR OFFICE USE
Required Inspection
Under Ground
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