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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: