4471 Lakeshore Ter Use BLUE or BLACK Ink
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i For Office Use �
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C��� �� ����� � Permit#: � ��:� i
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� Permit Fee:
3830 Pilot Knob Road � �
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
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Date: � � �-S �f� Site Address���r W�7l ��-��e.l���d� �-��a �' ��a�N Unit#:
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OW�1�J' � Address/City/Zip: ��7<filwv L f�/r�'r1 c� !.`� cM-.
'� Applicant is: Owner Contractor
� Description of work: J��l►^•
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� License# ��v 6 G�7 /� Lead Certificate#:
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� If the project is exempt from lead certification, please explain why:
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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 !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.
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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