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HomeMy WebLinkAboutLA108065 PERMIT C~ty Of LakCV111C Permit Type: Mechanical 20195 Holyoke Ave Permit Number: LA108065 Lakeville, MN 55044 (9~2) 985-4440 * L R 1 QJ 8 6 5 www.ci.lakeville.mn.us Date Issued: 09/17/2008 Site Address: 17224 Finch Path Lot: 007 Block: 001 Addition: Dodd Ridge PID: 22-20875-070-01 Use: *22-2 Q875-f~7f~-PJ 1* Description: Sub Type: Heating/Air Cond Work Type: Replace Description: Furnace & Air Conditioning Replacement Comments: Fee Summary: Description Amoun Revenue Code ME -Residential (Minimum) $39.50 1000-4154 Surcharge (.50) $0.50 1000-2127 Total: $40.00 i I Contractor: -Applicant - OWner: Lakeville Heating & Air, Inc Soren A Erickson 7151 Longview Lane 17224 Finch Path Prior Lake MN 55372 Farmington MN 55024 952 440-4328 ~ ) I HEREBY AGREE THAT THIS WORK WILL BE PERFORMED ACCORDING TO: (1) THE APPROVED PLANS & SPECIFICATIONS; (2) THE APPLICABLE CITY ORDINANCES & CODES; AND (3) THE MN STATE BUILDING CODE. Applicant/Permitee: Signature Issued By: Signature MECHANICAL PERMIT APPLICATION Office Use Oniy„_,,. / 2 t. ~ CITY OF LAILEVILLE erm~t Number ii ~ BUILDING INSPECTIONS DEPARTMENT r ~ • 20195 HOLYOKE AVENUE Received By LAKEVILLE, MN 55044 09 -1 7- 0 8 A 1 1 0 9 I N - ~ 952-985-4440 Date Receivedy ~ unvu~.ci.lakeville.mn.us r--~ DATE 11 ~ / YOUR E-MAIL ADDRES / SITE ADDRESS ~C d "7 in ~ %i G. TENANT SUITE N0. THE APPLICANT IS: ? RESIDENT OWNER ONTRA//CTOR NAME ~O? C Y1 i ~G/5 S o RESIDENT OWNER ADDRESS I 'I y ~ L CITY STATE ZIP. DAYTIME PHONE # WHERE YOU CAN BE REACHED `1 S' ~a/.~T_ ~ /r COMPANY NAME ~ et k>°v ~~i© ll LICENSE # ADDRESSpp ~ Jam/ ~ o y, r rw.- Z~~,., 2 CONTRACTOR CITY~r~T~~ ~,<~.P STATE /Y1s~" ZIP ~-~37~ CONTACT NAME FAX # DAYTIME PHONE # WHERE YOU CAN BE REACHED ~ COMMERCIAL ONLY RESIDENTIAL ONLY ? NEW HVAC SYSTEM ? FURNACE REPLACE ? GAS PIPING ? AIR CONDITIONER RNACE/AIR COND ? FIREPLACE ? REFRIGERATION REPLACE ' ?MISC ? GAS PIPING ? AIR COND NEW ? ADDN/REPAIR/REPLC PERMIT TYPE ? VENTILATION ? AIR COND REPLACE ? IN FLOOR ? FIREPLACE ? GARAGE HEATER WATER HEAT ? ADDN/REPAIR/REPLC ? VENTILATION ? BOILER REPLC IN FLOOR WATER HEAT ? MISC ; Residential Permits Available on-line ? NEW ? ADDITION ? ALTER /REMODEL TYPE OF WORK ? REPAIR ? REPLACE ? DEMOLITION JOB DESCRIPTION: SYSTEM MAKE: ~m~~ ~ T n SYSTEM SIZE: ©t~ RESIDENTIAL FEES: $40.00 ($39.50 + .50 surcharge) COMMERCIAL FEES: JOB COST: $ Example:. SI2,000 Sob Cost 1-1 /290 of contract cost up to $10,000 and $10,000.00 x 1.5% _ $150.00 I% of cost above $10,000 plus surcharge + $ 2,000.00 x t°~o = 20.00 (Surcharge =Contract Cost x .0005) + $12,000 x.0005 = 6.00 TOTAL = TOTAL $176.00 Minimum of $40.00 (39.50 + .50 surcharge) NAME OF APPLICANT (Please Print) APPLICANT'S SIGNATURE: DATE ~~~=ate r