4156 Arbor Lane 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
t
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:EA122810
Date Issued:05/20/2014
Permit Category:ePermit
Site Address: 4156 Arbor Lane
Lot:021 Block: 001 Addition: Wenzel 1st
PID:10-83570-01-210
Use:
Description:
Sub Type:Residential
Work Type:Alteration
Description:Stove
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Renae Frienwald
2200 Hwy 13 W
Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088
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 -
Jeanne R Kadrlik
4156 Arbor Lane
Eagan MN 55122
Genz Ryan Plumbing & Heating
2200 West Highway 13
Burnsville MN 55337
(952) 767-1000
Applicant/Permitee: Signature Issued By: Signature