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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 / l 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 i ( J i? / 6h11 . 10,--- Address: ! ` /4` els Az-, City: O I U a ' 1 ` �7 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 pia§' �i may'. Y Ua Z g g ^ Y 6nb ""' $ti �F t • � � _` .... � '" ; F� • . k �:r i C p {� # "T 'n I �1- s tira fw . S e_ J -, -. _ t - r - ' I!' x .. 1; h11W1['. s. ,,. is