4475 Lakeshore TerPERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA110101
Date Issued:04/23/2013
Permit Category:ePermit
Site Address: 4475 Lakeshore Ter
Lot:5 Block: 02 Addition: Cliff Lake Shores
PID:10-17785-02-050
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Kris Oien
3670 Dodd Rd
Eagan, MN 55123
Fee Summary:PL - Permit Fee (WS &/or WH)$55.00 0801.4087
Surcharge-Fixed $5.00 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 -
Onna Chung
4475 Lakeshore Ter
Eagan MN 55122
Champion Plumbing
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature
Use BLUE or BLACK Ink
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� Permit Fee: �
3830 Pilot Knob Road I I
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I �
Fax: (651)675-5694 I Staff: I
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2015 RESIDENTIAL BUILDING PERMIT APPLICATION
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� 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? �
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Yes No If yes, date and address of master plan: �
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£ Licensed Plumber: Phone: �
Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
Fire Suppression Contractor: Phone:
�N�TF;P��nS a�d sup�o�ti�r docu�e►�#�that yo�sw�rr���aa�cvr�si�I�red�o be pub��i��so�fc�nn. Pa�rl�+���o�'
t�e�n�`ar�a#��a��ay be ct�ass���d as nfln-pcab����`y��pro�a[e�aec�l�t�asons f�a��+o�ad�rr�J�t�re C3at�y t�
�� co�cl�de rf���t�e are t�a�1e s�cre��. ' ���
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.gopherstateonecall.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 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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Permit#: � �� I
���� O� Y���� I Permit Fee: �� �
3830 Pilot Knob Road � �
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I I
Fax: (651)675-5694 I Staff: I
i �
2015 RESIDENTIAL BUILDING PERMIT APPLICATION
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Date: � � �-s �� Site Addr��sl y��� ����e.r�°�c ��a �'�'` C��"�N Unit#:
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Applicant is: Owner Contractor µ��
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� Description of work: J���i'�
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� ; Construction Cost: /�l �` v� Multi-Family Building: (Yes /No� �
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Cor�tract�r
� Aaa�ess: 35� i/,�5s�u� G� h� .S�f` �sr c�ty: �'����,�u� • �
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� � License#: ��v d G�7 �!3 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? �
5
� Yes No If yes,date and address of master plan: }
� Licensed Plumber: Phone: �
�
Mechanical Contractor: Phone: �
Sewer&Water Contractor: Phone:
Fire Suppression Contractor: Phone:
NiDT�'.Plaua�ar��sup�o�v��ndocu�+�n�s t�aa�you s���re co.���a'�d i�b�p�rb�r'������. Fo�+r�s of
tf�e en�ort�ta�rot����be cl�ss��ed as�r��t p���e i�',�o��ro�u�d�e�pec�re��s��iat ta�or�t p�r,��i� G#�to
�.�.,.,� � G�Dl3���8�'���1�9� e��'�S'�!�dS�C�'B�'S. �., ,�.
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.org
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 S e uilding Code must be completed within 180
days of permit issuance.
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ApplicanYs Printed Name App c s Si ature
Page 1 of 3