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0512312014 11:26 Les Jones Roofing, Inc. (TAX)9528817009 P.0061016
Use BLUE or BLACK ink
For Office Use I
tl:
City of EaRan ; PerI
I l7 1
I Perrnlt Fee: -5 l + ~
31330 Pilot Knob Road
Eagan MN 55122 1 oats Received: I
Phone: (661) 676-6676
1 I
Fax: (661) 6765684 I stag:
1 I
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date; et 3 Site Address: t'1152 - it ~ gLrs A LA vo- Unit
Name: o l AR-was. 6 SaG. JE AwNE lei hone: 6 SI - 4 o s - 8 s~t~
Address (City /71p: 4l t V(, j4
1Z (Z .
Applicant Is: Owner X Contractor
Description of work: r-'t o vE
r
Construction Cost: 3 9 7. Multi-Family Building: (Yes X / No
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Company- Ae
NG Contact: 4We4 s A-tiO SOA
Addreae; U/. 8d X2 7 " City: Aaalg'e&b ~
State: _ (lam Zip: Phone: _ 9'SR - 7b 7 - IIIII
License 4 ago Lead Certificate M VAT- `f o 3 7.7 _
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:
CALL BEFORE YOU DIG. Cali Gopher Stale One Call at (681) 464-0002 for protection against underground utility damage. Gall 48 hours
before you Intend to dig to receive locates of underground utilities. MMUmpherstateonecall.om
I 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 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.
x_ cimis 4 00-0AI
Applicant's Printed Name
Applicant s Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA145627
Date Issued:09/18/2017
Permit Category:ePermit
Site Address: 4158 Arbor Lane
Lot:022 Block: 001 Addition: Wenzel 1st
PID:10-83570-01-220
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Michelle Trust A Schultz
5022 Woodlawn Blvd
Minneapolis MN 55417
(651) 452-0833
Standard Heating & Air Conditioning
130 Plymouth Ave. N
Minneapolis MN 55411
(612) 824-2656
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA167527
Date Issued:03/18/2021
Permit Category:ePermit
Site Address: 4158 Arbor Lane
Lot:022 Block: 001 Addition: Wenzel 1st
PID:10-83570-01-220
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Standard Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Schultz Michele Af Trust
4158 Arbor Ln
Eagan MN 55122
(651) 452-0833
Norblom Plumbing
1465 Selby Ave
St Paul MN 55104
(612) 827-4033
Applicant/Permitee: Signature Issued By: Signature