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4458 Lakeshore Ter Use BLUE or BLACK Ink r----------------_, I For Office Use � . � E3L �3`l(� � C�6� �1 ����11 � Permit#: � I � �� �� ; � Permit Fee: 3830 Pilot Knob Road � � Eagan MN 55122 � Date Received: � Phone:(651)675-5675 I � Fax: (651)675-5694 I Staff: i I I 2015 RESIDENTIAL BUILDING PERMIT APPLICATION S'.,ri z Z Date: � y �S �f� Site Address����'y��� ��-��e.l���� ��a �'�"` ���'�'~N Unit#: �,. �u.. .��.�.,. ..���.mw,�...�.,�m��_��_w..._�.,�.�n..� � .�..�,..._.,..�,...w.�.�..w..��..�� � / /� / � � � Name..�..� ..�^,.:,_,f'/"� �.,�.�6,�.��� �f��' Phone: � G C �� ����s�� � �r�s� - y� G /� �� � a ss�z� � (jti�i�r Address/City/Zip: .�a ��f✓�tf.lwvL �f�a'� c� G�-� � � � Applicant is: Owner Contractor .����..�� ����,�. ���....,�.a�.�.,m.��,.,��.��..�_.�.�,...,��,.,d..���.,.._..,.,�.�..���.��....��..�..,__� � Description of work: J 1��1'� ' Ty��e c�W9J�rk � � � � Construction Cost: /� �` v� Multi-Family Building: (Yes /No� ��.. � ...�..�.,..�.. ., �.�..m...,�,,. _ �.�.,,..,..u. .��� � � Company: ���f C C��R v�-f �r�'i�.=f���f ���. Contact: L°,��5 7���� � /� � .�/�'� �/o�� ± ��� � �� � Address: �5� �lC�S�UI�t, � � 3s/ City: ��"�/N�� • 9 C�l'�P1C'���' � � State:�Zip: �Sy�7 Phone:�G3-��.sb-o�tJ� Email: L�/'�1���-1��i.e,��.�(�'h./ouGT� � , �` � 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 � � 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�: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. x L���5 T Y�%t�jC��C-�..� X �~�. 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