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4474 Lakeshore Ter Use BLUE or BLACK Ink r-----------------, I For Office Use � ' � Permit#: �� �� �I Clty of ���a� � — � ,�� � � Permit Fee: ��� � 3830 Pilot Knob Road I I Eagan MN 55122 � Date Received: � Phone: (651)675-5675 I I Fax: (651)675-5694 I Staff: I I I 2015 RESIDENTIAL BUILDING PERMIT APPLICATION Date: fiL 1�/�S Site Address: ��{ ( y �,�'�'h���.°�v ` "%v��- (� J P�"�'/�J`� �Unit� � �u.�.� . f�Name:.�. ,ro�l �!f Y_.�,., �u.���.�.�,...,.,m.W�.�.o✓.�..�,A,w..�....�.�...n_�k.,�.....vµ_R�.�,.Phone::.�,�.�.__,�_,_.. �.�� V � S Ftss��l��� � � � `� 3 � Qwy��;r Address/City/Zip: ��'�"�-' ; , � Applicant is: Owner Contractor � .,�...��..�,�...,,��.,.dm�,.,,.�,,�.�..���,�.....�,.�.�,.�„a. �w,...�.rm,��,....�.��._�.,..�..�...�,.�.��.,�..,,�,.�.. �.,�.�.�.,� �' / .�.��$ Q���� Description of work: �r►'�� \ � �> ��' Construction Cost: Multi-Family Building: (Yes /No� �� .,.�. �..��,.�. ���...�... .�,�w ,.�., .�wx-,�,,�.�,.._..,,.n�,�..,.,�.��..�.,�.,, ,..�.a�„�,.�..�.,�..�., � � � Company: �t�t/lt� �hfi�� (.�1�C�a 1� �hc, Contact: /�'�f �i'Ut u� �-�" � ��, � � Address: JS�b ��G9,J �1'wv� �/J � suif� y�I City: �� � � � C ar�#ractor � State:�Zip: gSy��� Phone: �7(o3-S.S� �bn�� Email: ��� � a��J �in,cy� ��"�. � �� � License#: �C �d� �7�1.3 Lead Certificate#: �:.,��,.��._�.�.�....�w�,.� ��,.,w�.�.,�,,.,,,��...a9.u��� �.A.�.�>�n.�_,,�„��.�.,�,,..,�„��,.�.,.�,N.��.�.,u.���,w,�....�.�..��..��.,���..�,.�.�.,�,� f � 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: N�OT�':P��ns a�ad���or��.�g docc����#s th�,�o�s��ar�coa�`tl��e�I t��e p���s�arrr���lan. l�art�o��of �#�e�►far�ati��r.�aay�e Glassi�ed a�nvr�p�b�����a�prorr�dg spec�c reas+or�tf�a#wv�d per��f�re Ci�c t� co��e�ale�t��t t�e ar�t�a�le s�ref�. �m�� 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 S t Building Gode must be completed within 180 days of permit issuance. `�_ x �(�l f f Yl�(��t��-�r-� x ApplicanYs Printed Name Appli s Sign ture Page 1 of 3 PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA147114 Date Issued:12/12/2017 Permit Category:ePermit Site Address: 4474 Lakeshore Ter Lot:11 Block: 03 Addition: Cliff Lake Shores PID:10-17785-03-110 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 - Lloyd E Raymond 4474 Lakeshore Ter Eagan MN 55122 (651) 485-9406 Holmin Heating & Cooling Llc 3432 Denmark Avenue, #228 Eagan MN 55123 (651) 405-3853 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA149402 Date Issued:05/21/2018 Permit Category:ePermit Site Address: 4474 Lakeshore Ter Lot:11 Block: 03 Addition: Cliff Lake Shores PID:10-17785-03-110 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. Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener). Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087 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 - Lloyd E Raymond 4474 Lakeshore Ter Eagan MN 55122 Tony's Appliance 2090 County Road 42 West Burnsville MN 55337 (952) 435-2442 Applicant/Permitee: Signature Issued By: Signature