4458 Lakeshore Ter Use BLUE or BLACK Ink
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� Permit Fee:
3830 Pilot Knob Road � �
Eagan MN 55122 � Date Received: �
Phone:(651)675-5675 I �
Fax: (651)675-5694 I Staff: i
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2015 RESIDENTIAL BUILDING PERMIT APPLICATION
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� Applicant is: Owner Contractor
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� Construction Cost: /� �` v� Multi-Family Building: (Yes /No�
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� License# �e v 6 G 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? s
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� Yes No If yes,date and address of master plan: �
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� Licensed Plumber: Phone: �
Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
Fire Suppression Contractor: Phone:
lV�T�:P�5 a�d s��o���al�cuu�a�n�tfi�a#y�o�r 5�#��are car���i��-ed to�ptr��i�to��r�. Pct��s o�
t��in�`orr�a��r�a�r�a��ae ci�ssi�ed�n�n pc�b�""i�y��pro�l�s�ec�ic r�o���at w��p�rr���e Ci�t�'
cor��l�de t��t�� ar+�t��l���c�t�. _
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.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 S e uilding Code must be completed within 180
days of permit issuance.
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ApplicanYs Printed Name App c s Si ature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA145513
Date Issued:09/13/2017
Permit Category:ePermit
Site Address: 4458 Lakeshore Ter
Lot:19 Block: 03 Addition: Cliff Lake Shores
PID:10-17785-03-190
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 -
Roger Laufle
4458 Lakeshore Ter
Eagan MN 55122--247
St Paul Plumbing & Heating
640 Grand Ave
St. Paul MN 55105
(651) 228-9200
Applicant/Permitee: Signature Issued By: Signature