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4034 Beryl Rd PERMIT City of Eagan Permit Type: Building 3830 Pilot Knob Rd Permit Number: EA088599 Eagan, MN 55122 . Date Issued: 03/31/2009 (651) 675-5675~~~ EPermit Category: ePermit www.ci.eagan.mn.us lflflUl tflflLLL Site Address: 4034 Beryl Rd Lot: 8 Block: 5 Addition: Cedar Grove 5th PID 10-16704-080-05 Use Description: Sub Type: e-Reroof & Siding Construction Type: Work Type: Reroof & Siding Description: Census Code: 434- Occupancy: Zoning: Square Feet: 0 Comments: If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar. Pictures are not acceptable in lieu of inspections. When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to Fee Summary: BL - Base Fee $6K $132.75 0801.4085 Surcharge - Based on Valuation $6K $3.00 9001.2195 Valuation: 6,000.00 Total: $135.75 Contractor: -Applicant - Owner: Restoration Resources Aem Som 6850 Shingle Creek Parkway, #C-175 4034 Beryl Rd Brooklyn Center MN 55430 Eagan MN 55122 (763) 561-2698 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. Applicant/Permitee: Signature Issued By: Signature This request void 18 months from Lj L y% r 63565 Date of this Request I, as PTirc-ensed Electrical Contractor O Owner, do hereby request inspection of the above electri- cal wiring installed at: j~ F /~~ZJ Street Address or Route No. U ~ 12V city T Section Township Range County Which is occupied by (,yeti (N me of Occupant) Is a ioughin inspection required on this job? No Q- ' Yes El Ready Now ❑ Will CaUZ-" Power Supplier DA-L Address Electrical Contractor KI Y 1 Contractor's License o. (Company ame) Mailing Address A, (E ntr ctor or O ner Ma mg This Installation)? Authorized Signatur I a Phone No1 &J' Contra o or Owner Making T s Installation) Cj%py This inspection request will not be accepted by the U R State Board unless proper inspection fee is enclosed Minnesota State Board of Electricity I P.1954 University Ave., St. Paul, Minn. 55104-Phone 645-7703 REQUEST FOR ELECTRICAL INSPECTION 63565 CHEC- BELOW WORK COVERED BY THIS REQUEST P Type of Building New Add. Rep. Check Appliances Wired For Check Equipment Wired For Home ❑ ❑ Range ❑ Temporary Wiring ❑ Duplex ❑ ❑ ❑ Water Heater ❑ Lighting Fixtures ❑ Apt. Bldg. ❑ ❑ ❑ Dryer ❑ Electric Heating ❑ Commercial Bldg. ❑ ❑ ❑ Furnace ❑ Silo Unloader ❑ Industrial Bldg. ❑ ❑ ❑ Air Conditioner ❑ Bulk Milk Tank ❑ Farm ❑ ❑ ❑ List List Other ❑ ❑ ❑ Herers Hehers COMPUTE INSPECTION FEE BELOW Service Entrance Size: # Fee 11 Feeders&Subfeeders: # Fee Circuits: # Fee 0 to 100 Am s. / 7 &0 11 0 to 30 Amperes 0 to 30 Amperes 101 to 200, mps. 31 to 100 Amperes 31 to 100 Amperes Above 200_'Am s. Above 100 Amps. Above 100 Amps. Transformers ote Control Circ. Partial or other fee Signs Sp al Inspection Minimum fe Remarks -1r'r e. tc TOTAL F E cr'D i2/Ylr 1, the Aectrical Inspector; hereby certify that the above inspection has been ma e. ~G (Rough-in) Date (Final) d date o~ ?-l This request void 18 months from `a P CITY OF EAGAN Remarks * Cedar Grove Acquisition Addition CEDAR GROVE #5 Lot 8 Blk 5 Parcel 10 16704 080 05 Owner ~ i~t °C 4DUL f Street_ 4034 Beryl Road State Eagam, MN 55122 r Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. STREET RESTOR. GRADING SAN SEW TRUNK Z 1967 100.00 5.00 20 Paid SEWER LATERAL 31, 119611 525.00 26.20 20 Paid WATERMAIN * WATER LATERAL {p 1972 607.00 24.28 25 Paid WATER AREA STORM SEW TRK 1970 70.00 3.50 20 Paid STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. BUILDING PER. SAC 200.00 477 11-3-67 PARK CITY OF EAGAN 3795 Pilot Knob Road Eagan, MN 55122 N2 6777 PHONE: 454-8100 _ BUILDING PERMIT APPLICATION Receipt To be used for EGGRESS WINDOWS Est. Value $1,000 Date Jul ;Y 22 19 81 Site Address 4034 Beryl Road Erect ❑ Occupancy R.- Lot 8 Block 5 Sec/Sub. Cedar Grove 5 Alter gX Zoning Parcel # 10 16704 080 05 Repair ❑ Fire Zone NA _ cc Name Mr- & Mr6. William Y01z9 Enlarge ❑ Type of Const. V W Move ❑ # Stories z Address 4034 Beryl Road Demolish ❑ Front - ft. o Ci gan Phone 452-4514 Grade ❑ Depth ft. Name Northwestern Builders Approvals Fees o 0 f Address 8053 F. RlaomingtpriFrWy. Assessment Permit 17.50 i- city Phone Water & Sew. Surcharg& .50 Police Plan check FZ Name Fire SAC u~ Address Eng. Water Conn. <W city Phone Planner Water Meter Council Road Unit I hereby acknowledge that I have read this application and state that Bldg. Off. the information is correct and agree to comply with all applicable APC Total 18.00 State of Minnesota Statutes and City of Eagan Ordinances. Signature of Permittee A Building Permit is issued to: © on the express condition that all work shall be done in accordance .7th all applicable State Minnesota Statutes and City of Eagan Ordinances. Building Official CITY OF EAGAN Include 2 sets of plans, 1 site plan w/elevations & BUILDING PERMIT APPLICATION 1 set of ener calculations. ii 9 To Be Used For Valuation ® Date j Site Address /3,5e y~ OFFICE USE I Lot _'17d Block Sec./Sub.-G S Erect Occupancy Parcel /D j (D -7 0 o f -o ps" Alter ' Zoning ~ - Repair Fire Zone Owner: At fp s. ~cllLlas~rn TDc"V& Enlarge Type of Const. Address: Move # Stories .2s Demlish Front ft. City/Zip Code: Grade Depth ft. Phone g'Z - `f5 l APPROVALS FEES Contractor: Assessments Permit j Address: Water/Sewer Surcharge ,1a7-0-- Police Plan Check City/Zip Code: 34a=4S& j'S~fzU Fire SAC Phone 8ej,1,,' Eng. Water Conn. Planner Water Meter Arch./Eng.: Council Road Unit Bldg. Off. Address: APC City/Zip Code: Phone TYrAL $ I~ EAGAN .TOWN S H 1 P N° 1680 BUILDING PERMIT Owner c-------~ Eagan Township Address (present) -.--„~4c*.--•_ _.._....`.x:'"'~:----- Town Hall Builder _ .......3A/ Date Address DESCRIPTION _ Stories To Be Used For Front Depth Heigh! Est. Cost Permit Fee Remarks - 15- LOCATION Street, Road or other Description of Location Lot Block Addition or Tract This permit does not authorize the use of streets, roads, alleys or sidewalks nor does it give the owner or his agent the right to create any situation which is a nuisance or which presents a hazard to the health, safety, convenience and general welfare to anyone in the community. THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WORK IS IN PROGRESS. This is to certify, that-- ~ ( has permission to erect a------- , r ~l' ..........upon the above described premise subject to the provisions of the Building Ordinance for Eagan Ta-nship adopted April 11, 1955. / 15 {.4a-~.~ Per ------_F Crz .2 ' Chairmen of Tnwn }hoard uilding Inspector A CITY USE ONLY LOT RECEIPT SUBDt,131, v RECEIPT DATE: MECHANICAL PERMIT # 1999 MECHANICAL PERMIT (RESIDENTIAL) CITY OF EA6AN 3630 PILOT KNOB RD EAGAN MN 55188 Date: (651) 661-4675 Complete this section only if you are installing HVAC in a single family dwelling, townhome or condo under construction and not owner /occupied. • H-VAC: 0-100 M B T U $ 30.00 ADDITIONAL 50 M BTU 6.00 • Gas outlets (minimum of one required @ $3.00 ea.) State Surcharge .50 Total $ Complete this section only if you are remodeling, adding to, or repairing an existing single family dwelling, townhome, or condo. Please indicate if it is a new item, alteration, or repair. New XAlteration _ Repair _ Other Reminder: Call 681-4675 for inspections. Furnace Air conditioning 7v- - Air exchanger Other $ 30.00 State Surcharge ~j ~ Minimum Total Due 50 SITE ADDRESS: q 03q Oc r y$ OWNER NAME: C h e r) Th la Yi PHONE W97-9 (AREA CODE) ~ap INSTALLER NAME: Ir = L/ PHONE 1Q Jam- - L STREET ADDRESS: (AREA CODE) CITY: by I /I,, STATE:_ zip: 7 SIGNATURE OF PERMITTEE CITY USE ONLY L BL RECEIPT SUBD. RECEIPT DATE: APPROVED BY: ,INSPECTOR MECHANICAL PERMIT#: 1999 MECHANICAL PERMIT (COMMERCIAL) CITY OF EAGAN 8630 PILOT KNOB RD EAGAN, MN 55122 (651) 661-4675 Please complete for: all commercial/industrial buildings multi-family buildings when separate permits are not required for each dwelling unit DATE: CONTRACT PRICE: WORK TYPE: NEW CONSTRUCTION INTERIOR IMPROVEMENT DESCRIPTION OF WORK: FEES: 1% of contract price OR $30.00 minimum fee, whichever is greater. Processed piping - $30.00 CONTRACT PRICE x 1% PROCESSED PIPING PERMIT FEE STATE SURCHARGE ($.50 per $1,000 of ermit fee due on all permits.) TOTAL SITE ADDRESS: OWNER NAME: PHONE - (AREA CODE) TENANT NAME (IMPROVEMENTS ONLY): INSTALLER: ADDRESS: PHONE - (AREA CODE) CITY: STATE: ZIP: SIGNATURE OF PERMITTEE ~ N P I '1~ I Ili ~ Ili' MEMO city of eagan TO: DIANE DOWNS, UTILITY BILLING CLERK FROM: ED KIRSCHT, SR. ENGINEERING TECHNICIAN DATE: AUGUST 23, 1993 SUBJECT: STREETLIGHT ENERGY COSTS-CEDAR GROVE NO. 5 (208 LOTS) This memo is to inform your department to begin to invoice the energy costs at the single family rate effective August 1, 1993 to the property owners in Cedar Grove No. 5 Addition. Block 1, Lots 1-22 22 Block 2, Lots 1-19 19 Block 3, Lots 1-11 11 Block 4, Lots 1-16 16 Block 5, Lots 1-25 25 Block 6, Lots 1-22 22 Block 7, Lots 1-25 25 Block 8, Lots 1-5 5 Block 9, Lots 1-2 2 Block 10, Lots 1-23 23 Block 11, Lots 1-14 14 Block 12, Lots 1-9 9 Block 13, Lots 1-15 15 208 The City is currently being billed by Dakota Electric for streetlighting in the above listed subdivision. qv 4/4, Edward J. Kirsc t Sr. Engineering Technician cc: Mike Foertsch EJK/je EAG,LM TTv?NSU.3'P 3795 Pilot Knob nond St. Paul, Minnesota 55111 Telephone 454-5242 PERMIT FOR SEWER SERVICE CONNECTION ~y DATE• November 6, 1967 NUMBER d OWNER: Cedar Grove Const. Co. Address 4034 Beryl Road PUMBER Stein, Inc. TYPE OF PIPE „ Cast Iror DESCRIPTION OF BUILDI?vG Industrial Co=ercial~ Residential Multiple Dwelling No. of units x 1 Location of Connections: Connection Charge 6~ c-L.vU ~ F- Permit Fee d"9"C Street Repairs Total Inspected by: Date Remarks: By _ Chief Inspector In consideration of th.e issue arsl delivery to me of the abol-e peewit, I hereby agree to do the prorosed work in accordance v7ith the rules and regulations of Eagan Township, Dakota County, Minnesota ja Inc, Please notify when ready for inspection and connection and before any portion of the krcrk is covered. EAGAN TOWNSHIP BUILDING PERMIT N~ 2U0 Owner =1 r°. ......--f..:.....r' - Eagan Township Address (present) -•',/--_•-.-.-.:........~_,C-------------------------- Town Hall Builder Date Address DESCRIPTION Stories To Be Used For Front -Depth Height Est. Cost Permit Fee Remarks LOCATION Street, Road or other Description of Location Lot Block Addition or Tract This permit does; not authorize the use of streets, roads, alleys or sidewalks nor does it give the owner or his agent the right to create any situation which is a nuisance or which presents a hazard to the health, safety, convenience and general welfare to anyone in the community. THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WORK IS IN PROGRESS. This is to certify„ that ......___1................. ..has permission to erect a___...... _ upon •--...••---°u the above described premise subject to th provisions of the Building Ordinance for Eagan T6*nship adopted April 11, 1955. Per - . E _ Chairman of Town Board Building Inspector PERMIT NO. Eagan Township Dakota County, Minnesota Date Application for Building Permit Type of building or work contemplated. Circle correct descriptions. Resident~ i Commercial Industrial Other-----------• Build Enlarge Alter Repair Install- Move Wreck Other Dimensions.4:. A~ Cost .I~.~............ Details or remarks Location Number Street Between what cross streets I Size I Est. Valuation Lot Block Addition Rearrangement or Tract Owner Address . Contractor . Address The undersigned hereby makes application for a permit to _ do work as herein specified, agreeing to do all work in strict Total fee collected. accordance with the building ordinance adopted April 11, 1955 by the Eagan Township Board of Supervisors. Permit fees are not refundable. Signed 0- - 75 y AF, o;.i .r Y ,t..-..~•.` < ~l~. { r'; - T•i ~ t'}_- r ~F, erg a d~IA~~E { - .~1 ~ ~ y R~. qtr J~ "+Ot f + i . t Jl ~ ' it a t' ~ •:'}r, fit h~♦{~ .r 111 - ~4 ~ ~ _ t { ~ ~ ~ V 1 . ~ \h sq c 4 ill Y t LO T PA*OCK CE DAVI- w- RWV 41 wl" DAKOTA At 4f, **low so-V - IIIIIIIIIIIM 1' i CITY OF EAGAN 3795 Pilot Knob Rood Eagan, MN SS122 6777 PHONE: 4S4-8100 BUILDING PERMIT Receipt # To be used for FGGRESS 4"d1ND(Y:`;1') Est. Value "i1j.000 Date `duly 22 19 `~l Site Address ~ 3 BeT"rl Roal Erect ❑ Occupancy R3, Lot Block 5 Sec/Sub. Cedar Grove 5 AlterZoning Rl Parcel # L) 16704 030 05 Repair ❑ Fire Zone NA Enlarge ❑ Type of Const. v Name l • I.Irs. William Young: Move ❑ # Stories 3 Address ?4 Beryl Road Demolish ❑ Front ft. O City c'ip'an Phone 452-4514 Grade ❑ Depth ft. a Name -)rtawestern Builders Approvals Fees oou Address i. Blooming o F2RtY. Assessment Permit F'. City .f'1^`tOS2 Phone 884-8868 Water & Sew. Surcharg" Police Plan check FZ Name Fire SAC x9 Address Eng. Water Conn. 4 <w City Phone Planner. Water Meter Council Road Unit I hereby acknowledge that I have read this application and state that Bldg. Off. the information is correct and agree to comply with all applicable APC Tots( r' State of Minnesota Statutes and City of Eagan Ordinances. Signature of Permittee A Building Permit is issued to: Northwestern Builders on the express condition that oil work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official Permit $k Dot* Issued Pernditee Plumbing Mechanical INSPECTIONS DATE INSP. Rough-In Final Footings Date Insp. Date Insp. " Foundation _ Plumbing Frame/ins. Mechanical Final Remarks: ~ ~ -0 ~ `c--z^t..~Ci.~'h.-ti~ fi-fi.l-~l'f'rit, ~W"~/`~ ~~.'N~"►y PERMIT City of Eagan Permit Type: Plumbing Eagan. Permit Number: EA101131 Date Issued: 09/22/2011 OR Permit Category: ePermit 41~ it~ of E3 E Site Address: 4034 Beryl Rd Lot: 8 Block: 5 Addition: Cedar Grove 5th PID: 10-16704-05-080 Use: Description: Sub Type: e - Water Softener Work Type: New Description: Water Softener Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments: Kris Oien 3670 Dodd Rd Eagan, mn 55123 651-365-1340 Fee Summary: PL - Permit Fee (WS &or WH) $50.00 0801.4087 Surcharge-Fixed $5.00 9001.2195 Total: $».00 Contractor: - Applicant - Owner: Champion Plumbing Aem Som 3670 Dodd Rd., =100 4034 Berk 1 Rd Eagan NIN 55123 Eagan NIN 55122 (651) 365-1340 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 Cite of Eagan Ordinances. ApplicantiPermitee: Signature Issued Bv: Signature - - - - - - - - - - - - - - - - - For Office UsA C City Olf ERECEIVED j Permit ~E I ,1 I 3830 Pilot Knob Road DEC 2011 Permit Fee: _ d CJ Eagan MN 55122 Date Received: Phone: (651) 675-5675 I I Fax: (651) 675-5694. I Staff: I L-----------------I 2009 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: Site Address: Aem Som Tenant: 4034 Beryl Road Suite Eagan, MN 55122 RESIDENT / OWNER Name: 6514546189 ne: Address / City / Zip: CONTRACTOR Name: ORRLOM_RLt MARL IG4 ('C, License ®tl~ t Address: (8_12) 827-4033 City: 2905 GARFIELD AVE. SO. State: Zip: MINNEAPOLIS, MN 55408 Phone: Contact Person: TYPE OF WORK -New X -Replacement _Repair -Rebuild - Modify Space - Work in R.O.W. Description of work: r V te'r hatiff PERMIT TYPE RESIDENTIAL f Water Heater Water Softener Lawn Irrigation Add Plumbing Fixtures RPZ PVB) Main - Lower Level) Septic System Water Turnaround _ New Abandonment i RESIDENTIAL FEES; $50.50 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge) $30.50 Lawn Irrigation (includes $.50 State Surcharge) $50.50 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $.50 State Surcharge) *Water Turnaround (add $165.00 if a 5/8" meter is required) $100.50 Septic System New ($10.00 per as built) (includes County fee and $.50 State Surcharge) $90.50 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) TOTAL FEES $ t% --~j,~ 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. X V C~ L✓vl lr' ° ~ ~ V / r x Applicant's Printe Name A icant's Signa ure FOR OFFICE USE Reviewed By: Date: Required Inspections: _I bider Ground _Rough-In -,air Test __Gas Test -Final PERMIT City of Eagan Permit Type:Building Permit Number:EA112811 Date Issued:08/23/2013 Permit Category:ePermit Site Address: 4034 Beryl Rd Lot:8 Block: 5 Addition: Cedar Grove 5th PID:10-16704-05-080 Use: Description: Sub Type:Reroof & Siding Work Type:Replace Description: Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar. Pictures are not acceptable in lieu of inspections. When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to ensure maximum ventilation to attic. Call for final inspection after installation. Valuation: 8,000.00 Fee Summary:BL - Base Fee $8K $162.25 0801.4085 Surcharge - Based on Valuation $8K $4.00 9001.2195 $166.25 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 - Aem Som 4034 Beryl Rd Eagan MN 55122 Ashco Exteriors Inc 11164 Zealand Ave N Champlin MN 55316 (763) 225-8333 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA139294 Date Issued:10/18/2016 Permit Category:ePermit Site Address: 4034 Beryl Rd Lot:8 Block: 5 Addition: Cedar Grove 5th PID:10-16704-05-080 Use: Description: Sub Type:Windows/Doors Work Type:Replace Description:Two or More Windows/Doors Census Code:434 - 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: 4,000.00 Fee Summary:BL - Base Fee $4K $103.25 0801.4085 Surcharge - Based on Valuation $4K $2.00 9001.2195 $105.25 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 - Aem Som 4034 Beryl Rd Eagan MN 55122 (952) 688-6091 Custom Remodelers 474 Apollo Dr Lino Lakes MN 55014 (651) 784-2646 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA153720 Date Issued:01/16/2019 Permit Category:ePermit Site Address: 4034 Beryl Rd Lot:8 Block: 5 Addition: Cedar Grove 5th PID:10-16704-05-080 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace 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 - Aem Som 4034 Beryl Rd Eagan MN 55122 Metro Heating & Cooling 1220 Cope Ave E St. Paul MN 55109 (651) 294-7798 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA176533 Date Issued:05/19/2022 Permit Category:ePermit Site Address: 4034 Beryl Rd Lot:8 Block: 5 Addition: Cedar Grove 5th PID:10-16704-05-080 Use: Description: Sub Type:Fixtures Work Type:Replace Description:Bathroom(s) Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection. All tiled shower bases require a water test. Fee Summary:PL - Permit Fee (miscellaneous)$59.00 0801.4087 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 - Federal National Mortgage Assoc 1100 15th St Nw Washington DC 20005 Royal Flush Inc 22541 Typo Creek Dr NE Stacy MN 55079 (763) 439-7845 Applicant/Permitee: Signature Issued By: Signature