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4494 Lakeshore Ter Use BLUE or BLACK Ink r--------^-------� I For Office Use � ' � Permit#: � � ��� I y � ' � � 1� 0 � �� I Permit Fee: � 3830 Pilot Knob Road � � Eagan MN 55122 � Date Received: � Phone: (651)675-5675 I � Fax: (651)675-5694 i Staff: i 2015 RESIDENTIAL BUILDING PERMIT APPLICATION �L I�''/I S ���� C��5���✓� `�A't��f.t, ���-"` ,/�1� SSu n t#: Date: Site Address: �,.�,. � Name:��w�II�Y'�.� ..� ����a�,.�,�,�.��.�i/���.s,,�.�..,.�._ .,�.,u..�.�. Phone: �..,.m..,,�.,.��.�...�..� �..� F�aE3S�t���#� ,/ I` � � � � Address/Cit /Zi 7��% ���'-SLt„'�<� /"iN�(.' C�w Of�. /`�1J SS`12�7/" �; QWti�'1'< � Y p� ������� Applicant is: Owner Contractor �� ,�.w.�,,._���.�..,�.,. .....� - ,.._..,...�� --.m.w,....,,�.�e...u.�.�..�„_�.. .�.�$ Q���� Description of work: ��n� � y Construction Cost: Multi-Family Building: (Yes /No� � � ��. � �. ,� ,�,�,�..,. � ��. � � � Company: �t�� (�Ytf.�+� [�w1�.G�d 1� �hc, Contact:/-�`�f y� �� ��"' � a > }� 1 { / �02'_ �' �� 4, 3 Address: �Sab (�l�G�11�1wv� L�/J � Sulf�. .�s/ City: ,/ l I1�t� � Con#raeto�r � State:�Zip: �Sy�'� Phone: '7�3-5.��.vn''�.1 Email: ��� � �o��.I�,�in.c��(.�n��G�✓,�, � ' License# �C ��� 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? � � 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�T�:P��s a�d su��a��tlocu��r���th�yoc����ar�e ca�s�t�red t4 t�p��rr�far�, l�p�o��af t�i�in�orr�ation r�ra�6e c�s���ed a�nan p����f�t��rro�e spec�rea�or�t�a��t�per�#t�Cl�t�' co��l�ds t��t t�� �trade sec�+��. �� CALL BEFORE YOU DIG. Call Gopher State One Call at(651 j 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 1 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 f f r�,��.�,.-� X Applicant's Printed Name Appli s Sign ture Page 1 of 3 Use BLUE or BLACK Ink - r----------------� I For Office Use � � �3 3`� � ► C��� O� n���� � Permit#: � � I �� I � Permit Fee: 3830 Pilot Knob Road � � Eagan MN 55122 � Date Received: � Phone: (651)675-5675 I � Fax: (651)675-5694 � Staff: I I � 2015 RESID�NTIAL BUILDING PERMIT APPLICATION N��. -�lq� � �, s�.s�z z Date: � 2 �-S > � Site Address: ��-���.r��y� /-��a �'�" ���r Unit#: �w� F .�:.Name: r. _�w,°.^1�l`�., ...,��i�,�... S��l'. ._,��.�,.,.d� w . ....���...�d_aPhone: ._�..�,...__��...,�.w,�...,�.�_w� " � � � R�sidsr�#/ � y�'�2,m ���� � ./� .r � C�' ssjZz (,)��{;1'' Address/City/Zip: �' � ,lwo<- `��d'�, ct- G�^ /J � � Applicant is: Owner Contractor ��,.. ..�,��...�..��,.� - .�...�.,..e��o.u..�._.�..� ...�.�m..�x�,.,e�.�.,�.�,�..�_.��.���.�.�.��..�..�,....w...,... � Description of work: J f��i'� 7'yp+e a�F 1�lar� /,� � � Construction Cost: /�� �' �� Multi-Family Building: (Yes /No� � 3 � + � ���� j" �Y� � Company:�� cS ���4e� �U�%fr���-y��nr. Contact: ���5 vo9 kA.,�, ,�.�.,.�,,�.,.�,�,.� a � � � 35� �/,� �u�� �� �.� s��� ��;f � � � Address: �`5S s� City: �' �j/7�a� • � Co�a�ractor � �..�y�% Phone:�G3�.�.Sb-�� Email: L.cf'i.fc� �eJL.� �� � � :� State:�Zip: . �l3 �.u� �u ���, � � License# ��U o �7 /3 Lead Certificate#: �,::.�...��,�...��..�.�,�, �.�m..,� ...��,.��,K���a�„�.�.�VT.�.,n,�,�, �,.�,,.�. v,��......,w,�..�...._..w.m�...�,��.,,���w..�..�..,,..�.....�.a.�._n�.�.w.�.�.._ � If the project is exempt from lead certification, please explain why: � _ �,.,.��..�..,�,���..,o.�,.��,�.,��_ ��.....,_.�s,_ _.�,u...���.o�e�.�.,���,,.��..._ �..�.........��. - - 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? � , 9 � Yes No If yes, date and address of master plan: � � Licensed Plumber: Phone: � % Mechanical Contractor: Phone: � Sewer&Water Contractor: Phone: � Fire Suppression Contractor: Phone: lV�T�:#����$and�r�p�ar���docu�»+en�tfi�a��ou��s��are co�»��ed to be p��r�i�fic x�r�o�tf�. Po�ar�s c�#' ;:k t�e iu��'�rnra#i��►r���r�e cfa�si�ed a�n�n pe�b�e�`y��pro�v�s�pec��rea�nr�s tha#t�a�r�p�t���:G3�+�a � c�r��l�r/�#�a�'t�s �re t�°a�le,�c�°e#�. � CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. CaII 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 St e uilding Code must be completed within 180 days of permit issuance. x L��'��.5 �1��(,c�:�.�,� X .�---� ApplicanYs Printed Name App c s Si ature Page 1 of 3 PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA156422 Date Issued:06/28/2019 Permit Category:ePermit Site Address: 4494 Lakeshore Ter Lot:1 Block: 03 Addition: Cliff Lake Shores PID:10-17785-03-010 Use: Description: Sub Type:Residential Work Type:Replace Description:Air Conditioner Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State 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 - Lorraine M Ovshak 11192 Aspen Glen Dr Boynton Beach FL 33437 Haley Comfort Systems 4320 Hwy 52 N West Frontage Rd Rochester MN 55901 (507) 281-0138 Applicant/Permitee: Signature Issued By: Signature