3786 Grey Dove LaneRESIDENT / OWNER
Name: S Q /?7 rS 1 Phone:
Address / City / Zip:
CONTRACTOR
Name: 1 r 4 0 L too /i iol A e 31� Li License #: t/ROo 3 tr
j
Address: 1 0 a3 o J16 le E I st/6- City: B1 (tint
State: /4A/ Zip: SS L I Phone: gjz`3a 2-7/ 7Z,
Contact: . el,) r J f Email:
TYPE OF WORK
New > Replacement Additional Alteration Demolition
Description of work:
NO TE Roo mounted and g ind moun m ech anical equipm (s r e q uired abe screene
CodePl contact the Me chanical Insp ect or r for informati permit s creening r neth
i ity
s
PERMIT TYPE
RESIDENTIAL
XFurnace
COMMERCIAL
New Construction Interior Improvement
Unit
by Fire
Air Conditioner
Install Piping Processed
Air Exchanger
Gas Exterior HVAC
Heat Pump
Under / Above ground Tank ( Install / Remove)
Other
** When installing /removing tank(s), call for inspection
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
Surcharge
TOTAL FEE
= $
- If Permit Fee is Tess than $1,000,
= $
- If Permit Fee is > $1,000, surcharge
$1,000 Permit Fee (i.e. a $1,001
_ $
4 11° Gity of Eagan
Tenant:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
Date: 06 V 6-/0
Applicant's Printed Name
2010 MECHANICAL ICAL PERMIT APPLICATION
Site Address: 371?‘ qv, !J Owe 24,
enar
x
App
Permit #: /
Permit Fee: 6C/ -
Date Received: 62 ` / c
Staff: (
Suite #:
Use BLUE or BLACK Ink
CALL BEFORE YOU DIG. CaII 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.org
1 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 without a permit; that the work will be in accordance
with the appr ed plan in the case of work which requires a review and approval of plans.
ions `t nder G
creetl
g - 3 Z b8, 3 -~~a 3 74 ~~7$ , 3~ 80, 37 8 4.3'18 (o ► 3J&1 o C-sreA~ Dzv .
Use BLUE or BLACK Ink
For office Use
i
t
Permit 16 ,3` (10
t
City of Ea
~ Permit Fee: ~ 1 I ac.5 . D ~J i
3830 Pilot Knob Road t t
I Date Received: 12CI I t-,7 I
Eagan MN 55122 I I
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 l Staff t
L---------------- I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION j,
• - - ~ 3790 7r`'? LAILI-
Date iCT-a~'t3 Site Address: 37L4 3~7,a, 377N 3775, 3')80. 3-)Sy, Unit#:
F----- ---..........e_..o.~ Name: Phone:
Resident/
I Owner i Address /City /Zip:
t
i
Applicant is: Owner Contractor
Description of work: Q
Type of Work i ^
; Construction Cost: d Ol a0z) Multi-Family Building: {Yes / No
Company: ~~~°ta2~~f1 no>fct~ ar,' Contact: d~
I i Address: City
Contractor i z#
State: tyl A ~ Zip: 10"53 -1 Phone:
( License #`f Lead Certificate #
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes ____No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor. Phone:
Sewer & Water Contractor: _ Phone:
1 NOTE. Plans and supporting documents that you submit are considered to be public information. Portions of
f the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that rheyare trade secrets
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protectinn aciainst underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. ,
I hereby acknowledge that this information is complete and accurate; that thr, ,r rk 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 pem-tit, stud work is not to start without 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.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
Applicant's Printed Name Applicant's Signature
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