4474 Lakeshore Ter Use BLUE or BLACK Ink
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3830 Pilot Knob Road I I
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I I
Fax: (651)675-5694 I Staff: I
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2015 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: fiL 1�/�S Site Address: ��{ ( y �,�'�'h���.°�v ` "%v��- (� J P�"�'/�J`� �Unit�
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Applicant is: Owner Contractor
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��' Construction Cost: Multi-Family Building: (Yes /No� ��
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� License#: �C �d� �7�1.3 Lead Certificate#:
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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: �
� Licensed Plumber: Phone: �
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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
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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.
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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