4126 Arbor Lane 0512312014 11:27 Les Jones Roofing, Inc. TAX)9528811009 P.0101016
Use SLUE or BLACK Ink
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For Office Use I
j Permit ~ g` g 3 j
City of Eqan ( r 1 Fee: 15-71.-7_45
Perot t
3830 Pilot Knob Road
Fagan MN 65122 Date Received: (1
Phone: (651) 675-5675
I I
Fax: (661) 67MB94 i Staff:
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: S11 Site Address; 4120- q1 Z.'2 - qI2$-q 124 ~ -a LAAi ko""' Unit
Name: yo m-E Aizaoas As hoc. ~e-Ar x,A-- #4 hone: to Sj- 4O-S- `a_5' C
r.' Address /City IZip!
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Applicant is: Owner X Contrector
Description of work: F-VA-4 b VC AWA /LEDc.3ce
Construction Cost: ` 3 -2 Q r X
Multi-Family Building: (Yes / No
Company: ArS ToNg3 q~ofiallr &mc. Contact: d::'mat r A-NDE72so&/
Address: 9 Y / IN. go"' orAzzm- City: &e416lA61-22A1
r' State: Mn/ Zip: - ,~,f <`2a Phone: 95-A - 74 7 - AW _
License D Lead Certificate .VA-7- qO 3 'PR
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:
r
CALL BEFORE YOU DIG. Call Gopher State One Call at (661) 464-0002 for protection against underground utility damage. Call 48 hours
before you Intend to dig to receive locates of underground uglltles. www ooaherstateonscall.ora
1 hereby acknowtedge that this Information Is complete and accurate; (hat 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 VA be In
accordance with the approved plan In the case of work which requires a reYlew and approval of plans.
Exterior work authorized by a building permit Issued In accordance with the Minnesota State Building Code must be completed within 980
days of permit Issuance.
,Crs AV06I20-t7,J x roz' de, e
Applicant's Printed Name Applicant's Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA146509
Date Issued:10/30/2017
Permit Category:ePermit
Site Address: 4126 Arbor Lane
Lot:013 Block: 002 Addition: Wenzel 1st
PID:10-83570-02-130
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
Surcharge-Fixed $1.00 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 -
Barry Bates
4126 Arbor Lane
Eagan MN 55122
(651) 207-5071
Standard Heating & Air Conditioning
130 Plymouth Ave. N
Minneapolis MN 55411
(612) 824-2656
Applicant/Permitee: Signature Issued By: Signature