4053 Beryl RdciTY OF EAGaN ? ;.5 18025
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121'. ? y A
PHONE:454-8100
BUILDWG PERMIT Receipt
To be used for C?? ???TION Est. Value ?51000 Date JLTNE 15 , 1 s90
S+te Addrss ??? BERYL RD
Lot Block SecJSub. `
Parcel No.
W Name CREW" r HAMI.TT
o Address
City Phone _-A 4 .?- *?11 b-
,o Name SAME
0
,Q Address
~ City Phone
Name _
Address
Clty _
Phone
I hereby acknowlege that f have read this application and state that the
information is correct and a,gree to comply with I applicable State oi
Minnesota Si'atutes and Cit?of Eagan Ord4nances???
1
Y
I Signature of Permitee
'CREWRYs ? HAMMTT
A Buildin Permit is i ~ •
g ssued to.
I on the express condition that all work shall be done in accordance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
BuNding Officiai
IIL
OFFICE USE ONLY
M-1
Occupancy - FEES
Zoning ? 72#00
(Actual) Const - Bldg. Permit
2.50
(Allowable) - Surcharge
_
# of Stories ?. ?.
Length
224- Plan Review
Oepth - SAC, City
S.F. Total -?- SAC, MCWCC
S.F. Footprints ,
On Site Sewage _ Water Conn
On Site Well ^ Water Meter
MWCC System ^
Acct Deposit
City Water _
"PRV Required ` S/W Permit
Booster Pump - S!W Surcharge
Treatment PI
APPROVALS Noad Uait
Planner --- park Ded.
Council
Bidg.Off. _ Copies
•
! Variance TOTAL
Permit No. Permit Holder Date Telephone #
WATER
SEWER
PLUMBING
H.V.A.C.
ELECTRIC
Inspection Date Insp. Comments
Footings 1 ?1c3 QG3 ???
Foundation
Framing „
Roofing
Hough Plbg.
Rough Htg.
Isul.
Fireplace
Fnal Hig.
Final Plbg.
Const. Meter Plbg. Inspector - Notify Plumber
Engr./Plan
Bldg. Final !
Deck Ftg.
Deck Final
Well
Pr. Disp.
CITY OF EAGAN Remarks
Cedar Grove Acquf.sition
Addition CEDAR. GROVE 16 Lot _ S Blk 4 Parcel 10 16704 050 04
Owner OYC?{LiJ•'?Lti?jf-?Street 4053 Ber'yl Rc3ad State ?g?, M 55122
improvement Qate Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK
* SEWER LA7ERAL 1972 1,304.00 52.16 2.'r? Paid
WATERMAIN
* WA7ER LATERAL 1972
WATER AREA
STORM SEW TRK 'L 1974 7e.00 4.66 15 $g7.d
STORM SEW LAT
CURB & GUTTER
S1qEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC
PAR K
EAGAN TOWNSHIP
BUILDING PERMIT ?
Owner --••---•=- L4,xo-?__....6?'7?-?-?.------.?__..---------.>,,•---...---
Address (Preseni) :---.-r.----•• ..............---- -
F3uilder ---?--•----•--•------•---•-•---?---•-----------.:_.:_
Address -- -- - --•----------•---------•--•---•-••----•--••-------?---------•--•'----•-----
DESCRIPTION
N° 1398 -
£agan Township
Town Hall ?
Date --/
-? - -- --•------•-•----------
Diones ro tse useu Fbr Fronf Depth Heighf. Est. Cosl -Perma! Fee ' R
-
-- -- emarks
--
J -- - , --
Sireei, Roz
7 -7?- 3
or other Descripf]On af
?
I.OCATION
?-T
or Traei
- - - ' i i I
This permif does not "suthozize the use of s2reets, roads, alleys or sidewalks noz does ii give the 'owner or his agent
the righi !o creatd any SifuaYion which is a nuisance or which presents a hazard to the healih, safefy, convenience and
generai welfare to anyone in the community.
THIS PERMIT MUST IIE KEPT ON T}H,E PREMISE WHYLE THE WORK IS IN PROGRESS..
This is fo ceriify, ihai__.J?.._.e?---=_._haspermission, to erect a__..----...--c_..Z.-...... uPon
the above dFSCribed premise subjecf io the provisions of the Building Ordinance for Eagan?Township adop32d?April 11,
1955. 11 ------•-----••----._...__ ?.?fiL?'---Zi'•=::`4_••:--? ?----._..._...: Per . ---------•- °•--•-- 2 t
t"? ?
(r4.-?J ?3?`? --''?'t-?---••C'_.-Cc.L;l. . ..........
Chairman of Tnwn Board Building Inspecior
? ? '
CITY OF EAGAN
3830 Pilot Knob Road
' Eagan, Minnesota 55122-1897
f (612) 681-4675
? SITE ADDRESS:
4053 BERYL RO
I.QTd 5 F3LOCK° A
? CEDAR GRQUE
f P.I. N. s 10-16704-050-04
PERMIT
PERMIT TYPE: BUILDI NG
Permit Number: 032417
Date Issued: 07 /01j 9 g
REMARKS:
FEE SUMMARY:
Base Fee
Surcharge
' 7ata1 Fee
UALUATT(1N
$26e50
.._......_. . 5 0
$27<P10
$700
CONTRACTOR:
' r
?
OWNER: - Rpplicant -
MAMMIT7 GREGqRY
4053 BERYL RR
EAGAN hiN 55122
(612)452-5081
ereby acknawledge th?t I 'have read
. Vr,., a
CITY OF EAGAN
3830 Pifot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
4053 BEFtYL Rp
Lt77': 5 EiLOCK: 4
CEpAR GR(7VE 5TH
P.Z.N.s 10-16704-050-04
DESCRtPTIOW
PERMIT
PERMIT TYPE: BUx LDING
Permit Number: 032093
Date lssued: 05j 26/98
RERpOF
Bulldkn:q Permit Type 5F (MIaC. )
86 il411 ri?' A?ork Type REPAIR
?ens u s Cpd? 434 A.L"C. RESSDENTIAL
? ?,.
? ?
; sx •.
?P ? . 3 -- ? '?<.
?, Z ' d A J 3 3Y , ,,.,.
.? w . . ? .,, . . , , „ o.h
! REMARKS:
i FEE SUMMARY:
Bd52 F@B
Surcharge
' Tota1 Fee
VALIJATIqN
$74.75
1.50
$76.25
$3q VCJW
A
COIVTRACTOR:
APPLICANT/PERMITEE SIGNATURE
71 A-t*I I*?- f' ? r? h' F' a. ?. ? a r i w _
GREGoaY
4053 BERYL Rq
EAGAN MN 55122
(612)452-5081
ISSUED : IGNATURE
CITY OF EAGAN NO 18025
. 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
BUILDING PERMIT Receipt #
To be used for GARAGE ADDITION Est. value $5, 000 Date JUNE 15 , 19-92
Site Address 4053 BERYL RD
Lot 5 Block 4 Sec/Sub. CEDAR GROVE 5TH
Parcel No.
W Name GREGORY F HAMMITT
3 Address 4053 BERYL RD
° City EAGAN Phone 456-5081
Zo Name SAME
oa Address
Uw
*- City Phone
?
W W Name _
M" ? ; Address
a W City -
Phone
I hereby acknowlege that I have read this application and state that the
information is correct and agree to compiy ith ali applicable 5tate of
Minnesota Statutes and Ci?poi Eagan
?
Signature of Permitee
A euilding Permit is issued GORY F HAMMITT
on the express condition that ali work shall be done in accordance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official
Occupancy
Zoning
(Actual) Const
(Allowable)
# or stories
Length
Depih
S.F. Total
S.F. Footprints
On Site Sewage
On Site Well
MWCC System
City Water
PRV Required
Booster Pump
APPROVALS
Planner
Council
Bidg. Off.
Variance
OFFICE USE ONLY
M-1
FEES
72.00
2.50
_ Bldg. Permit
? Surcharge
14' Plan Review
22' SAC, City
- SAC, MCWCC
` Water Conn '
- Water Meter
Acct. Deposit
` S/W Permit
- S!W Surcharge
Treatment PI
Road Unit
- Park Ded.
? Copies
-- TOTAL
74.50
u ? S
110246
1990 BUILDING PERMIT APPLICATION
CITY OF EAGAN
SINGLE FAMILY DWELLINGS
2 SETS OF PLANS
-3 REGISTERED SITE SURVEYS
T ???nF F?FRC`V ('AT ('T1 erT T?
MULTIPLE DWELLINGS
COMMERCIAL
2 SETS OF PLANS 2 SETS OF ARCHITECTURAL
REGISTERED SITE SURVEYS - & STRUCTURAL PLANS
(CHECK WITH BLDG. DEPT.) 1 SET OF SPECTFICATIONS
1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS
# OF RENTAL UNITS
# OF FOR SALE UNITS
PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING DAY
OF MONTH IN WHICH REQUEST IS MADE.
LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
NOTE: ADDRESSES FOR CQRNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS
DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED.
PERMIT MUST SHOW A LICENSED PLUMBER.
A-c) r> i Tl o ANAT-W-H G7 b -
_j 3
ht
To Be Used For: ? Valuation: .(fDate:
Site Address
Lot 5 Block 4
ParcelfSub s 41?
Owne r e r F. vn r,,t r''E- {-
Address lOS CY' ?
?1
City/Zip Code _h74a? cn A/h iv`,5)??
Phone
S r ?-?' ra? 5' 0 51
Contractor
Address
City/Zip Code
Phone
Arch.fEngr. _
Address
City/Zip Code
Phone #
Occupancy
Zoning
Actual Const
Allowable
# of stories
Length
Depth
S.F. Total
Footprint S.F.
OFFICE USE ONLY
M -1
FEES
-?-
161 '
22'
On site sewage+
On site well _
MWCC System ?
City water _
PRV ?
Booster Pump !
Bldg. Permit
Surcharge
Plan Review
SAC, City
SAC, MWCC
Water Conn
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment Pl.
Road Unit
Park Ded.
Copies
SUBTOTAL
Penalty
TOTAL
r7 2 . c7c-)
APPROVALS
Planner
Council
Bldg. Off.
Variance
r
?
?
t
__? ?. ?• « IL
' .X ?' .i, ,-w y„ ? sr?••'`l .?Kt;??,; i?? ?'?
r
ENdE INEERiNGf INC
.
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Y Mortgage Loan Survey f or
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l,?rf?•c? ;!?,s ? __ ? d?r y' '- --?f ?'???? -__.-_?._ R:: rq ?`f' ?U?f?i4't`j?t! FNu.`1V?t ??fe'ci . ?l?R?°. ? ?
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N!!.
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 singie
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 g
Block 13, Lots 1-15 15
208
The City is currently being billed by Dakota Electric for streetlighting in the above listed
subdivision.
Edward J. Kirsc t
Sr. Engineering Tecnnician
cc: Mike Foertsch
EJK/je
?
EAGAN TCMWNSHIP
BUILDtNG PERMIT
Owne= ........... ,.?
-- ----••-- --•-••--•- •- ••---•---•-------------------•---•----•--•----------
t
Address (present) -•----- -------------- --------- ?..-'-2'- ? _? ? -•- -•-- --=--••----•-°
?----•
Buiider ---------- ---------------------------------------------------------------- ---
Address ----------------- -.......... .................... ----------------- --------•------•----•-----
DESCRIPTION
N? 1563
8agan Township
Town Hall
Dafe ................................................
52ories
- To Be Used For Froni
- Depth Heighf st. Cos! Permii Fee Remarks
e?...cz
.?
-
, ?
7,
.
LOCATIOPi
Street, Road or o3her Descriptioas of Locaiion I Lo3 Block ' Addifion or Tract
This permit does noi authorize the use of sfreets, roads, alleys or sidewalks nor does it give ihe owner or his agent
ihe right to create any situation which is a nuisance or which presents a hazard Yo the healYh, safety, convenience and
general welfare to anyone in fhe communiiy.
THIS PERMIT MUST BE KEPT ON THF{ PREA2ISE WHILE TFiE WORK IS IN PROGRESS.
This is to ceriify, thaL-----?.?.=.•--•----••------ --------- haspermission to erect a..-•---.c??)nip -••`---•......... ...... upon
the above described premise subject to the provisions of the Building Ordinance for Eagan T adopted Apr il 11.
1955.
.------.------- _?r-'---;,? -?!?__ Per ._.---•-------------------•--- ----
-------------? _.---- - - - ---- ???- ?Ch.airman nwn Board A?- ? Building Inspecfor
rt
{ , . .
f ' _..._ _ . .. . . .
?ry
N
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?
S2417 98 BUILDING PERMIT APPLICATION (RESIDENTIAL) TZ7 -?
CITY OF EAGAN
3830 PII.OT KNOB RD - 55122
681-4675
New Construction Requirements
? 3 registered site surveys
? Z copies of plans (include beam & window sizes; poured fnd. design; etc.)
? 1 energy calculations
? 3 copies of tree preservation ptan 'rf tot ptatted after 7/1/93
required: _ Yes ! No
DATE: -7
DESCRIPTION OF WORK: cf/o,I
STREET ADDRESS:
J
LOT: ? BLOCK: SUBD./P.I.D. #:
(;,1m.'n.; rr\
PROPERTY
OWNER
CONTRACTOR
Name: ??cc m in ,? 61 vc-c C;+° Phone #:
Last First
/J
Street Address: ( O 6 3 ?GC' f :'j ? ? t ?.
City f Lk <? ?11) State: ?n Zip:
Company: 5 e I f
Street Address:
City
RemodeVReoair Requirements
? 2 copies of plan
? 2 site surveys (exterior addkions & dedcs)
? 1 energy calculations for heated additions
CONSTRUCTION COST; ?(-n t ?, 0-?
Phone #:
License #
State: Zip:
Phone #:
Registration #:
/ c I ' ` C?
ARCHITECT/
ENGINEER Company:
Name:
Street Address:
City
State:
Zip:
Sewer & water licensed plumber (new construction ony): . Penalty applies when address chang
and lot change is requested once permit is issued.
1 hereby acknowledge that I have read this appfication and state that the information is coRect and agree to m ' all applicabl
State of Minnesota Statutes and City of Eagan Ordinances.
Si9nature of Applicant: ?r 'OFFICE USE ONLY
Certificates of Survey Received Yes No
Tree Preservation Ptan Received Yes No Not Required
OFFICE USE ONLY
BUILDING PERMtT TYPE
? 01 Foundation ? 06 Duplex
0 02 SF Dwelling ? 07 4-plex
0 03 SF Addition ? 08 8-plex
0 04 SF Porch ? 09 12-plex
??QS SF Misc. ? 10 = plex
WORK TYPE
O 31 New Alterations
O 32 Addition ? 34 Repair
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
? 11 Apt./Lodging ? 16 Basement Finish
0 12 Multi Repair/Rem. ? 17 Swim Pool
? 13 Garage/Accessory ? 20 Public Facility
? 14 Fireplace , ? 21 Miscellaneous
? 15 Deck
0 36 Move
? 37 Demolition
Basement sq. ft.
Main level sq. ft.
sq. ft.
sq. ft.
sq. ft.
sq. ft.
Footprint sq. ft.
Planning Building
MC/WS System
City Water
Fire Sprinklered
PRV
Booster Pump
Census Code.
SAC Code
Census Bldg
Census Unit
Engineering
Variance
Permit Fee Valuation: $ 00
?----
Surcharge
Plan Review
License MCNVS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit S/W Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
% SAC
SAC Units
7?. q s"
1998 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PII.OT KNOB RD - 55122
681-4675
New Construction Reauirements RemodeVReaair Reauirements
? 3 registered sfte surveys ? 2 copies of plan
? 2 copies of plans (inGude beam 8, window sizes; poured fid. design; etc.) ? 2 site surveys (exterior additions & decks)
? 1 energy calculations ? 1 energy calculations for heated additions
? 3 copies of tree preservation plan if lot platted after 7/1/93
required: _ Yes _ No
?
DATE: CONSTRUCTION COST;
DESCRIPTION OF WORK: _ '( ?' ?L?:?c? ?
STREE ? DRESS:
l T. ? BLOCK: SUBDJP.I.D. ?' '
'l
PROPERTY
OWNER
CONTRACTOR
(.-, Phone#: (61-4)y 5 ,.7 - T C?
Name: ?2 1
? ,
Last First
Street Address: ? J -3 `'? ??''7
City .L ci ? C; . State: /Ati
Company: Phone #:
Street Address: License #
City
ARCHITECT/
ENGINEER Company:
Name:
Street Address:
City
Zip: 6- 6
State: Zip:
Phone #:
Registration #:
State:
Zip:
Sewer & water licensed plumber (new construction only): . Penalty applies when address chang
and lot change is requested once permit is issued.
I hereby acknowledge that I have read this application and state that the information is coRect and agree to com y with all applicabl
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant:
-?
OFFICE USE ONLY
Certificates of Survey Received Yes No
Tree Preservation Plan Received Yes No Not Required
4 - a
OFFICE USE ONLY
BU{LD{NG PERM{T TYPE
? 01 Foundation ? 06 Duplex
? 02 SF Dwelling 0 07 4-piex
? 03 SF Addition ? 08 8-plex
? 04 SF Porch ? 09 12-plex
? 05 SF Misc. ? 10 = plex
WORK TYPE
O 31 New ? 33 Alterations
? 32 Addition 0 34 Repair
GENERAL INFORMATION
Const. (Actual) _
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
O 11 Apt./Lodging ? 16 Basement Finish
? 12 Multi Repair/Rem. ? 17 Swim Pool
? 13 Garage/Accessory ? 20 Public Fac+lity
? 14 Fireplace ? 21 Miscellaneous
? 15 Deck
O 36 Move
? 37 Demolition
Basement sq. ft.
Main level sq. ft.
sq. ft.
sq. ft.
sq. ft.
sq. ft.
Footprint sq. ft.
APPROVALS
Planning
Building
MC/WS System
, City Water
Fire Sprinklered
PRV
Booster Pump
Census Code.
SAC Code
Census Bldg
Census Unit
Engineering Variance
Permit Fee
Surcharge
Plan Review
License MCNVS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
Valuation: $
% SAC
SAC Units
? INS1 l:aCTIVN iti
Jl
llRD
l
C.IT? C? EAGAN .
.
..
PERMIT 'f`1(PE: ? ? ???? ?
?f? ?'ilpt ?Ct1ob Fioad Permit Number: ? .s
? ? ? }? ? ? ?
F?t, I?inrtesota 55122-1897 Date Issued:
G-} V7?
4? 75
m..G?TY?"M_?;? .. ,
?' 1704
.
SaRESS' . ? t? t=. ?? ?? t c=r ? u 4 aPPLICAIdT:
? t????? ??? HANHx T
r???? OROvE hT?t
' ?R
RYPE:
TYPE C>F Wt3RK:.
. ?ESCRIPTU?P6 RLcROOF
m
a
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r09'4g AW""4
BERYL #0
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Pormit HokMt ?e Tolophone #
P#,.13 NG
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l?ki?t [? k3sg?: ?amr?8 .
FOOTkMG$
FOLM
FiiAA,fit+1G
ROOFtN€',,
PQtJGH Pl.t)MO4JG
F't.B#m
AtR TES7
RCUGFi
HEATiNG
GA..S $VC
TESi'
IPlSUt
GYPBOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAt PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
DOAAESTIC
METER
IRRtGAT14N
METER
FLUSH
A9AINS
CONDUCTIVIN
TEST
HYDROSTATIC
TEST
BSMT R.I.
'
BSMT FIfdAL
DECK FTG
QECK FINAL
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA114044
Date Issued:09/10/2013
Permit Category:ePermit
Site Address: 4053 Beryl Rd
Lot:5 Block: 4 Addition: Cedar Grove 5th
PID:10-16704-04-050
Use:
Description:
Sub Type:Reroof
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.
Carbon monoxide detectors are required by law in ALL single family homes .
Jackie Terrell
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 -
Gregory F Hammitt
4053 Beryl Rd
Eagan MN 55122
Walker Roofing Company
2274 Capp Rd
St Paul MN 55114
(651) 251-0910
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA138575
Date Issued:09/06/2016
Permit Category:ePermit
Site Address: 4053 Beryl Rd
Lot:5 Block: 4 Addition: Cedar Grove 5th
PID:10-16704-04-050
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.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
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 -
Gregory F Hammitt
4053 Beryl Rd
Eagan MN 55122
Angell Aire
12253 Nicollet Ave S
Burnsville MN 55337
(952) 746-5200
Applicant/Permitee: Signature Issued By: Signature