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4471 Lakeshore Ter Use BLUE or BLACK Ink r----------------� i For Office Use � , ; 1 ��2-; C��� �� ����� � Permit#: � ��:� i i � I � Permit Fee: 3830 Pilot Knob Road � � 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 �l ..� S.f�z Z. Date: � � �-S �f� Site Address���r W�7l ��-��e.l���d� �-��a �' ��a�N Unit#: �,,.�.. �4Name:W� . e.µ`.���� .,, .��i�..., ����wm,�.��.w.�,.u�_.., ...,....,..,u�..�,.m Phone: . _ �.,_�d.�a.,..��,.��.�..,m«��,_.„,� G � �tes�r�e�t! � �t/L�l- �4' �� /� � a SSiz� � OW�1�J' � Address/City/Zip: ��7<filwv L f�/r�'r1 c� !.`� cM-. '� Applicant is: Owner Contractor � Description of work: J��l►^• �' 7'�B Of V#la�k ;� /� �b. do �> ;� Construction Cost: � � ����� Multi�Family Building: (Yes � /No_) �� � �.�..�..,.�,....,�,,�..��,.�.� .�,. �.�,,.,� � .�... � # Com an �� (>���0� L�""���O✓ �c. Contact: ��'s �o�� � � p Y���f C 1 � � ` a {/O�JI � � � Address; �5� �jC�,��L(lr�, �� �� `���t 3s/ City: �'��/�:�7�• i Gar�ra.ctor � � � � State:�Zip: �-�y�% Phone:��3—SS6-oac13 Email: l.�%"�fG���r,�(�'h.(1U�iT� � �` � � � � License# ��v 6 G�7 /� Lead Certificate#: �,��,,.�..,�.��.�.�..w��,�m��,��__�.�,�.,�,�.��.�.,...�....�4�,we..,,�,�.��r..,..��,�.�.�.,w�,����.����.�.,.w.�,���a,,w.�.,„.�,��..�.� � If the project is exempt from lead certification, please explain why: � �...,�,...�...� ��,.a.���.�_a,r.��,.,�,�,.��..n �.�,� ��� ��,.�...�..��..F.a�.�.,� ..�.,. ��.�.�..,.�.� 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? # a Yes No !f yes,date and address of master plan: � � Licensed Plumber: Phone: � Mechanical Contractor: Phone: � Sewer&Water Contractor: Phone: Fire Suppression Contractor: Phone: �lV�JT�;Pla��s ar�d��o���dnr����s t�aa#yo�s�rb��t a;re co��f�red to,��r�l�c rr��'�r�a�. Po�o�af t�e�n�'�r�ta�oa�may�e class��ed as�t�n pa�ab�c i��o�pro�r�+d�spec��i�r�as����hat r�v�d perr�a�#��e Ci�to � �c�nr.��de#hat�are t�ade,secre�. 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����'.S / I��GCa..�.ti.i X ./L�----- Applicant's Printed Name App c s Si ature Page 1 of 3 PERMIT City of Eagan Permit Type:Building Permit Number:EA177226 Date Issued:06/21/2022 Permit Category:ePermit Site Address: 4471 Lakeshore Ter Lot:7 Block: 02 Addition: Cliff Lake Shores PID:10-17785-02-070 Use: Description: Sub Type:Windows/Doors Work Type:Replace Description:One Window/Door Census Code:434 - Residential Additions, Alterations Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow windows, call for framing inspection. Call for final inspection after installation. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Valuation: 1,500.00 Fee Summary:BL - Base Fee $1500 $62.50 0801.4085 Surcharge - Based on Valuation $1500 $0.75 9001.2195 $63.25 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 - Judy Elaine Jensen 4471 Lakeshore Ter Eagan MN 55122--244 Renewal Andersen 1920 County Road C West Roseville MN 55113 (651) 264-7052 Applicant/Permitee: Signature Issued By: Signature