1700 Four Oaks Rd Unit 226BRESIDENT / OWNER
Name: X.,4-14■Ac 4;c j C Phone: mil ' 3n -319,Z
Address / City / Zip: / 7 �4 7-,..".....3(
CONTRACTOR
Name: - 1)e." 6 ) :Z.A.C3
V Argil
'S4
Address: 19145 7 City: rac
State: MR Zip: 554Z Phone: (051- 79x`1 -,5 c �,`
Contact: f tw. Email: - i' G «Gi4_j - cl
TYPE OF WORK
? New eplacement Additional Alteration Demolition
Description of work: ____ er Ai `..t adA
NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City
Code. Please contact the Mechanical Inspector for information on permitted screening methods.
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
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 $ ,2- ccc 0 x 1%
I
$ 5tt5 Permit Fee
- If Permit Fee is Tess than $1,000,
= $ o 5 v Surcharge
- If Permit Fee is > $1,000, surcharge
$1,000 Permit Fee (i.e. a $1,001-
_ je
_ $ 5+_„7.0
, TOTAL FEE
�City otEaQan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
Date: 4/47 - Site Address: / 7 )J S' -'' 04-
Tenant: Y5-14so' c \ \ e .
Applicants Printed Name
�o Ck
ffBi7 2010 .
Staff:
2010 MECHANICAL PERMIT APPLICATION
I hereby acknowledge that this information is complete and accurate; that the work will be in confo )
Eagan; that 1 understand this is not a permit, but only an application for a permit, and work is not to f a
with the approved plan in the case of work which requires a review and approval of plans.
x C A 1 \ x .44/111 '
Applicant's Sig
Use BLUE or BLACK Ink
laM
Permit #:
Permit Fee:
070
Date Received:
Suite #: .20 \
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.gopherstateonecall.orq
with the ordinances and codes of the City of
rmit; that the work will be in accordance
Rough: in
Exterior HVAC
FOR OFFICE USE
Required Inspection '
creening I nspection