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
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iPerrnit Fee: �
3830 Pilot Knob Road
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I �
Fax: (651)675-5694 � Staff: i
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2015 RESIDENTIAL BUILDING PERMIT APPLICATION
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Date: Site Address: � / Unit#:
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� 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: �
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� Licensed Plumber: Phone: �
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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.
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Applicant's Printed Name Appli s Sign ture
Page 1 of 3
Use BLUE or BLACK Ink
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i For Office Use �
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City of ����� , Permit#: � �
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� 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
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Date: � �� �S ��� Site Addre���Z� ������ ��-��c.1����� �'��`� �"� ���"�� Unit#:
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Applicant is: Owner Contractor
' Description of work: J l��r
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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
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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.
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Applicant's Printed Name App c s Si ature
Page 1 of 3