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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 r----------------� I For Office Use � I ' � Permit#: � � ��� Clty of ����� � �� � � 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 � I 2015 RESIDENTIAL BUILDING PERMIT APPLICATION iZ J��1 S� ��� � �� 5� �'���dY��c�v �' �,r, /�I� SSI t-Z.- � �, Date: Site Address: � Unit#: �.,.�,_ ` Name:�r . /1 �1t'Y� �: ���L�.�����G�/,�,5,.�..�.,�.m��������.�...�,�.. ,�..Phone: ��..�.,._,.,.L,�.w�..�,..�_� � F�ESiCIe��/ � V � � Qy���;r � Address/City/Zip: C�"'�' � �, Applicant is: Owner Contractor �,�..,.�,.� . ��� ��....�.��..,.,���.v...�..�...���,...��..��,,.,�.�,.�.n, � .��� Q���r� � Description of work: ��✓�� �` ' �: � Construction Cost: Multi-Family Buiiding: (Yes �/No� �� j � � �Company: t•t/�ts � hfi��tl�0�� �G�d 1� �hc, Contact: ��-T t!'�t u�. ��"' �� , ) � t/az�_ }�/�I1�b l� # � � JS�b V'G�I;f�3t�w li� � sui e �s J � ' � C�r�ractor � Address: � City: / r � � State:�Zip: gSy�� Phone: '7G3-SS� .��'`�J Email: ��� ��a�.I��m,c+-wl ��G�°�f. ; � License#: �G '�d� 7�.3 Lead Certificate#: �,: �.,�.,,�.�.��.w�...�,�_...�..r.��,,._.��..�.,,w,�. eaA�,�.�,.�.���,�.�.�..,a�...,��„���.�.m��,.�.,.�..,�.,���,u,n,�w..�.�..,�,..v.,.�.��,�.. ,.,,�.,,...�. � 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? � t Yes No If yes, date and address of master plan: � i £ 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. `�.�. X �u1,� �r<,���,��,---�-� x '�� Applicant's Printed Name Appli s Sign ture Page 1 of 3 Use BLUE or BLACK Ink - r------------------, I For Office Use � ' �i 1 � L i 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 -� S;fi z Z Date: � � �-s �� Site Addr��sl y��� ����e.r�°�c ��a �'�'` C��"�N Unit#: � � �.�-Name:��,ra4 /'�!"�..n .._u,�,�,�i�x�.,.�., �f'�%�I'_,,,,W w�r,�,�_w ,,,,����,.�_w Phone: .�...w.,,,�,..,�.�..�..,�,w��..�a (.�(� L � �tes��d�tt � ��73- �Y7S' L � f �' rr' a ssrz� �: C1YA►t��!' Address/City/Zip: � < .lwo c, ��d'K cz C� Applicant is: Owner Contractor µ�� �,�...,�,w.,�.�,..�,�.:..�._ a.�.,�,�.,-,�...�„�����,., _ _-�.�.�,,.,�-�..�..,�.�..,�,.,�.�.,M.u. .�,a��„�_.�.,.���a.�a.���...�.�_.�....�.....�..�... � Description of work: J���i'� �' Tppe 4#�l�lOrfC � ,J � ; Construction Cost: /�l �` v� Multi-Family Building: (Yes /No� � ��,..��..�,� ��.�;:�..�..�,.��..�.�_.n.�.�, ..,.�.,�..,�.,..�.�,.��...�...,..w.,.,,...�,.w.,, _.�...�.,,,.,� -�,.,�. �„�.� � � Com an C� ES ��v�-f �l�'i�:l"�-��f nc. Contact: ���s ��`��t4a,�, � P Y� ��� � s Cor�tract�r � Aaa�ess: 35� i/,�5s�u� G� h� .S�f` �sr c�ty: �'����,�u� • � � /� ,- �(, � � 1 � � State:�Zip: �-Sy�% Phone:��3��.s6-���13 Email: L-��'�-1C�Caa�/�I��t,l�.e�+.ItaGT��j,� : � � � 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. x (��/��.� / /�+`�(,(s�,,��/ X �� ApplicanYs Printed Name App c s Si ature Page 1 of 3