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4454 Lakeshore Ter PERMIT City of Eagan Permit Type: Plumbing Permit Number: EA106640 Date Issued: 08/31/2012 Permit Category: ePermit Site Address: 4454 Lakeshore Ter Lot: 21 Block: 03 Addition: Cliff Lake Shores PID: 10-17785-03-210 Use: Description: Sub Type: e -Water Heater Work Type: New Description: Water Heater Meter Size Meter Tie Manufacturer Serial Number Remote Number Line Size Comments: Tony Boerner 2090 County Road 42 W Burnsville, MN 55337 952-435-2442 Fee Summary: PL -Permit Fee (WS &lor WH) $55.00 0801.4087 Surcharge-Fired $5.00 9001.2195 Total: $60.00 Contractor: -Applicant - Owner: Tony's Appliance Nancy J Pickett 2090 County Road 42 West 4454 Lakeshore Ter Burnsville MN 55337 Eagan MN 55122 (952) 435-2442 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.  ApplicanvFermltee: Nignature issued tiy: NIgnature Use BLUE or BLACK Ink r-----------------� I For Office Use � • � Permit#: t L � � j Clty of ����� � ��� � iPerrnit Fee: � 3830 Pilot Knob Road Eagan MN 55122 � Date Received: � Phone: (651)675-5675 I � Fax: (651)675-5694 � Staff: i I � 2015 RESIDENTIAL BUILDING PERMIT APPLICATION tL ����s y�%S� �u/�!J�'�v r�r, �wr� �, ��c��..,. ��f^' �S�� � Date: Site Address: � / Unit#: � �,Name:.�._o .�/1�l�����_., ����M�,�a����.���,��,.._,���.�,..m,��...�W..�,�. Phone: .e..�,.,�.�.�.,�.�,,.,w.��._..,� l./ � � Resid��J z C � � Q�y��;r � Address/City/Zip: ��"� �' � . . Applicant is: Owner Contractor �,.,�.,��`,.�.�., ,��,,w..�.��. __ ._.�..,,,�.,_ �.�,,.,��.�,����...,��.�x_��,....�,�.�..o��.,,��.�.....�„�� � Q� Description of work: Wi�� Z T�� O 1�1 ; � � Construction Cost �Multi�Family Building: (Yes /No� �� � �� � � Company: �t���� .h�� .�.�. ���o l���hc, Contact: /-�^�.I �Ut r��. �--- � /� (�' (�''`'� , � � JSab , ' �y >J� � Su1f� �.�s/ City: / � � j C011#Ya�tOt' = Address: �G� �?w� �i ✓ � State:�Zip: Ssy�t� Phone: '7(o3-S.S��.b�'�� Email: ��� � �o��.I�,��n.c�wl ���eT vl��'-` � ./"SG �dG7�t,3 � � License# Lead Certificate#: �� ,�x�W.��..�...�....�.r,� �����..,�,����.�� .�a�..,.._.� _�,_.,.,�,,��,.��,,�.�.��..w.y„�.m.��,��..,�...,.,W...�..��.,�...,�.o,.�.���,a..ww.�.,w.wM..a�._�..� ���a � If the project is exempt from lead certification, please explain why: COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING � b 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: � E � � Licensed Plumber: Phone: � I Mechanical Contractor: Phone: Sewer&Water Contractor: Phone: Fire Suppression Contractor: Phone: N�OTE:P��s a�d su�ort�g alocur��,�fis tha#you sw�#:�r�co�d�red�o�b���bt��r�r���'�n. Pt��c��nf t��i�form�#i�n�a,y be c/a�si�ed ars rron p�vb��if y�v���o�i�e s�ec�i�t�g�r��t-��#�uo�f�l p�rc�a�t�e C�'#y t� conc�de��t��e ��e tr��te�c��ts. �. � 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.qopherstateonecall.orq 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 1 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 S t Building Code must be completed within 180 days of permit issuance. X �(.4�f T r(�(���+.�� X -�_ Applicant's Printed Name Appli s Sign ture Page 1 of 3 Use BLUE or BLACK Ink r-----------------+ i For Office Use � ; � �j � City of ����� , Permit#: � � � �:�; � Permit Fee:�� 3830 Pilot Knob Road � �— � Eagan MN 55122 � Date Received: � Phone: (651)675-5675 I � Fax: (651)675-5694 I Staff: I � I 2015 RESIDENTIAL F�UILDING PERMIT APPLICATION .�.� S'.f�z Z Date: � �� �S ��� Site Addre���Z� ������ ��-��c.1����� �'��`� �"� ���"�� Unit#: ,�u� �.�.,��r.�..�....�,,.��.�,,�.��.�.�.,�.��,�,��. ����� ���,������.���,..w � Name: ���'�� ���� ��°� Phone: 'F�S�'rld@11#/ �/ �> /� �?Wt�E�I' Address/City/Zip: y7 S�- �'1 �� ��l�J"t.I�dwvL �-t i-d� cc. C� � � .�S/Z� Applicant is: Owner Contractor ' Description of work: J l��r �,Ty�3e 0��1�(?rk� � /, � Construction Cost: /�� �` �� Multi-Family Building: (Yes /No� � ��� Company: ��x c� ���v� �"""���"'�o l ,�c. Contact: ��fis �Ya�`'�-d„�-, � � Address: ��� �j��-�`5S�'�A � �� /`� '���� 3� City: fa��/Z%�7.c1'ti C��'�1 aC'��D1' State:�Zip: �-Sy�% Phone:iG3-'S.S6-o�t,f� Email: 1��1���.1L.��,F,�C.�'t../�a��� ' License#: ��v 6 G�7 �!� Lead Certificate#: If the project is exempt from lead certification, please explain why: 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: Fire Suppression Contractor: Phone: 1VOT�:Pl�l�S c'ii?#��1�3/10l'tl#��dOCtliil�l�itS t�?c�`j+OtJ Sklbtlki�'e�!'8 COI?S!`C��'@d t0',b@�Ttlibl�'C 1'!?ft?f►�?r��'1Q►1. P0�0►?S.:O� ' t�e tia�'arinat�on�ay be cla�si�etl as non-perbli�.��i y�a�r prrrr��d�e�peci�ic r�;�sr�rr�f�a#wai�{�1 per��t��ie G'��y t� 'co�rcl�de i�i�at tJ�� a�e�ra�e.,se�►e�t�.: 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.qopherstateonecall.orq 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 St e uilding Code must be completed within 180 days of permit issuance. x ���5 ���GC.�.�� X -�'`--- Applicant's Printed Name App c s Si ature Page 1 of 3