3623 St Francis Way Unit FRESIDENT / OWNER
Name: - -- , c., G 0 __14/e.<16
Address / City / Zip: J .1 127ItL
/ Phone: , /- L i - 1 , "' 5119
3 —S /la
CONTRACTOR
Name:
Zi
Address: OI1jrLII2_J
1/i J& License #:
City:..
State: L r a ' ►y - Zip: _65"101
Contact:
Phone: 4 / & 3 - E' fJ
- -- Email: L ___ °H L° 'h i_e
TYPE OF WORK
New
_placement
1\1/2k lit 4
Additional _ Alteration Demolition
—
Description of work:
_
a. 1 60._X,t.d re i °C.. -_ l ?Dzit
NOTE: Roof mounted and ground mounted mechanical equipment is required to be s eened'by City
Code. Please contact the Mechanical Inspector for information on permitted- scree t ing methods.
PERMIT TYPE
'
RESIDENTIAL
t./ rnace
COMMERCIAL
� New Construction Interior Improvement
___ Install Piping Processed
Air Conditioner
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 Tess than $1,000,
= $__ Surcharge
- If Permit Fee is > $1,000, surcharge
$1,000 Permit Fee (i.e. a $1,001-
= $ TOTAL FEE
City of Ea�all
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
x_nt)
Applicant's Printed Name
FOR OFFICE USE
Required Inspections: Under Ground
uuN10REVD
Use BLUE or BLACK In
For ffi e UUse
Permit #: [ /
Permit Fee: '
Date Received:
Staff:
2010 MECHANICAL PERMIT APPLICATIQN II
Suite #:
Date: 4' -'Y' /6 Site Address: 321 h)L1j
Tenant:
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 an codes of the City
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to st. • •ut a permit; that the wor will be in accordant
with t approved plan i the case of work which requires a review and approval of plans. ,..--
Rough In Air Test Gas Service Test
Applicant's -'- ature
Date
In-floor-Heat Final
eviewed By: