1222 Balsam Tr EWATER SERVICE PERMIT
PERMIT NO.:
DATE:
No_ of llnir.•
No.:
10 oomply with fhe City of Engon
Connection Charge:
Account Deposit: _
Permit Fee:
Surchnrge:
Misc. Charges: -
Totol:
Date Paid:
SEWER SERYICE PERMIT
Pilat Knob Road
, MN 55722
PERMIT NO.:
DATE:
No. of Units:
Address:
agree to eomply wifh the Citry of Eugan
of Insp.:
Connection Chorge:
Atcount Deposit: _
Permit Fee:
Surcharge:
Misc. Charges: -
Total:
Date Paid:
Dote of Insp.; 1,,1_ , 1
. . ctnr oF eaGAN
3745 Pilot Knob Rwd Eogan, MN SSIZZ N2 6096
PHONE: 4548100
BUILDING PERMIT Receipt # - --
To be used for Est. Value Dat e , 19
5ite Address Erect ? Occuponcy
Lot Block Sec/Sub. Alter ? Zoning
pa?l # Repair ? Fire Zone
Enlu?ge p Type of Const.
W. Nome Move ? # Stories
=
"
Address Demolish ? Front ft.
Grade fl Depth h.
ce Approvab
?o Nome
Assessment _
u? ?dr?
~ Ci Phone Water & Sew.
Police
F,wu N°rT1e Ffre
_? Address Ena.
<"' I City Phone Plunner _
Councll _
I hereby ocknowledge that I hove reud this application and stote thot Bldg. Off.
the informotion is torrect ond agree to comply with all appliccble
Stote of Minnesota Stotutes and Ciry of Engan Ordinonces. APC -
Permit
Plan check
SAC
Water Conn.
Water Meter
Road Unit
Total
Siynature of Permittee I
A Building Permit is issued to: on the express condition that
all work shall be done in accordance with all applicable Stote of Minnesota 5tatutes and City of Eogon Ordinances.
Building Officiol
P*rroit ?j psN Iwu" PWOIMM
Plumbin9 C - / Fi? ?
Mechonical - D
INSPECTIONS DATE INSP. Rough-in Finol
Footings ys/?y/K(J te,_ I Insp. OMe Insp.
Foundation f f - l? Plumbin9 „
Frame/ins. Mechanicnl
Finol
Remorks:
111.24fit FI;. -0 pA,..c. F?Z
1 ..3 0 • b? `?,.?,l, ?..+?? ?,,,.,?.,a?.-?+ r..
Dw7t,r,?,, ? e.J..?•
/4 .?-?•?Z?,?O ?Q ?' •
` ?? - -
r-
.
,
?
??? .
42
. CITY OF EAGAN
3795 Pilot Knob Roed
Ea9an, Minnesore 55122
No. P6ona: 454-8100
PERMIT
Date:
? ..,
Site /lddress: - ' '
Lot Block Sub/Sec.
INSPECTOR NOTIFICATION
REQUIRED BY LAW
FOR ALL INSPECTIONS
Reteipt No.:
Single
Residential
Multi Res., Comm./Ind. I
Nome (1ref*ory r. DalliaJL New//11ter./Repafr. ? Address DuPont r,rr ,
Cost of Installation
City -- ` r' Phone: #' - Permit Fee
Nome
? Surchorge
?
? Address '
City Phone: Total This Permit is issued on the express condition that all work shnll be done in accordance with all npplicoble Stote of
Minnesoto 5tofute5 ond City of Eogan Ordinances.
Oificiol
No. 0r
arY oF EaGAN
3795 Pilof Knob Roed
Eogon, Minnmota 55122
Phone: 454-8100
PERMIT
Date:
iaiS-so
Slre Addreu: Tr.
Lot Block Sub/Sec.
Name ;?TY ?'' i?A.111aub
` .
? Address Ave
?
City : . Phone:
Name
.
g Address -
T
r-
12
City Phone: -
INSPECTOR NlJTIFICATION
REQUIRED BY LAW
FOR ALL INSPECTIONS
Receipt No.:
Single
Residential
x
New/Alter./Repoir
Cost of Instailction
Permit fee
This Permit is issued on the express condition that oll work shcll be done in ot[ordance with oll oppliCOble StOte of
Minnesota Stotufes ond City of Eogan Ordinonces.
Building Officiol
CITY OF EAGAN Remarks
Addition Wilderness Park Lot 23 R,k 1 Parcel 10 84250 230 01
0 wner?(?'?1Q street 1222 East Balsem Tx'ail State Eagan,MN 55123
Improvement Date Amount Annual Years Payment Receipt Date
STREET SUR F.
STREET RESTOR.
GRADING
SAN SEW TRUNK 12 1 176905 8.80 20
SEWER LATERAL
WATERMAIN
WATER LATERAL
WATER AREA ' r
STORM SEW TRK 1
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK
i F
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EACAN
3830 PILOT KNOB RD - 55122
651•681-4675
New Construction Reouiremenls RemodellReoair Requirements
• 3 registered site surveys showing sq. k. of IoL sq. ft. of house; and all roofed areas . 2 copies of plan
(20%a maximum bt coverage aliowed) . 1 set of Energy Calculations for heated addilions -
• 2 copies of plan showing beam & window sizes; poured tound design, etc.) . 1 site survey for exterioredditlons & decks
• 1 set of Energy Calculatwns
• 3 copies of Tree Preservation Plan if lot platted after 7(1193
. Rim Joist Detail Optons selection sheet (bldgs with 3 w less units)
DATE //I/l'YY'/1 "ti!(J"' i V
JOB SITE ADDRESS J? ?S(
IF MULTI-FAMILY BUILDING, HOW MANY UNITS?
PROPERTYOWNER lf??k(YJ
TYPE OF WORK ?n t?tA I) Gi Plrz CJIprPrY-G
APPLICANT Oq\ eS? ?,?O to jr\?I
ADDRESS ? .'S'FSQ (il
PAGER # CELL PHONE #l
VALUATION (EXCIUDING LAND)
FIREPLACE(S) _0 %/l _2 _3
PHONE# 9S???X?/,-C??SFT
VnI, ZIPCODE .SS?.3 ?
FAX #
NEW RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY
energy code Category _ MINNESOTA RUI.FS 7670 CATEGORY 1
(check one) - Residential Ventilation Category 1 Worksheet Sub I d ?
- Energy Envelope Calculations Submitted
_ MINNESOTA RULES 7672
- New Energy Code Warksheet Submitted By
Plumbing Contractor:
1'lumbing SysCem Incluctes:
Water Soltener
Water Heater
vo. of 13aths
Phone #:
Iawn Sprinkler
No. of R.I. Baehs
Fee: $90.00
Mechanical Contractor. /`i Y' e S(LY P?di'hEY'/?/? /?/?PSl? Phone #??
Mcchanical System Includcs: _ Air Conditi ning Tee: $70.00
Heat Rccovery Systcin
Sewer/Woter Contractor:
Phone #
All above informa[ion must be submitted prior to processing of application.
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with
all applicable State of Minnesota Statutes and City of Eagan Ordinance .
C ?
Signature of Applicant lildIf
?
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 7J01
, CITY OF EAGAN
„ 3795 Pilot Knob Rmd Eagan, MN SS722
PHONE: 454-8700
BUILDING PERMIT APPLICATION Receipt {p
N? 6096
.?1?-!??/
Te be uaed for SF DWG Est. Volue 57?000 Dore 8-18 , 1g 82
Site Address 1222 E. Balsam Trail ? erea ? Occuponcy R?
Lot 23 Block 1 sec/Sub. Wilderness Park Alter ? Zoning RZ
po?? # Repoir ? Fire Zone Z
Eniorge ? Type af Const, V
? Name GTegor,y F. Dalhaub Move ? # Stories
-
z
3
Address 12$07 Du ont Ave S.
p
Demollsh
? ?
Fronf ft.
-?
°
Cit Bl g 7?(,.7
1T'T1R1J'1 ? ? P Phone ?r- Grude ? Depih
fr.
? N Dalhavb Rnildina (`o Approvals Fees
p ome n
?? Address S2IIle
H r:... o?___
Nome _
Address
I hereby ocknowledge ttwt I
the information is correct ?
Stote of Minnesota $tatute
this application ond state that
to comply??v ith all opPlicable
of Eaa? ?rdinauce?.
AssessS?nt R_l5_R!1
Water & Sew.
Police
Fire
Eng.
Plunner
Council
BId9. Off.
APC
Permit ? 71.UU
su.che.ge 28-50
Plan check 75.50
SAC 525.?0
Water Conn..?Q.?Q'
Water Meter 60 _ 00
Rood Unit ? ?5. nn
P rk Ded ? 0 0O., .
7oro? ? ?li50 DO
Signature of Permitt ?
A Bullding Permit is iss? r? GY'2g0 alhaub on the express condition thot
oll work sholl be done in ac?c ?ont?}??with o app?l'coble STate gf Minnewto Statutes and City of Eagan Ordinances.
Building Officicl ?.??/'? -? ?'+? - -
(? ?o
CITy pg EAGAN Include 2 sets of plans,
1 site plan w/elevations &
` BOILDING PERMIT APPLICATION 1 set of energy calculations.
7 p GD - -
'Ib Be Used For .Gtia Valuation Date d ?
Site Pddress OFFICE USE ONLY
Lot Z3__ slocac sec./sub.bE.4,t6P.?'is?srdl??grect ?
Parcel #:
Owner: 6xiogeg4k /=
Address: /2,YT 7 pL,Pati?52?
City/Zip Code: 2U.c'`v,cjSV>L??y <fC .-?? 7
Phone #:
Contractor:
Address: S10411?77 i3
City/Zip Code:
Phone #:
Arch./Ehy.:
Address:
City/Zip Code:
Alter
Repair
IIziaxge
Nbve
Demlish
Grade
Occupancy /e-?
Zoning /a /
Fire Zone .3
Type of Const. V
# Stories
Front ft.
Depth Sa ? ft.
APPRC7VATS FEES
Assessments Permit
laater/Sewer Surcharge
Police Plan Check ?
Fire SAC
gng. Water Conn. 30.s
-
Planner WatQr Meter a
Council Road Unit
Bldg. Off, ?.?,?.C?d I ?2n 'g
AFC
Pharie #: ' TCfrAL
This request void
18 dtant6s from
Date of this Request 8-29-1980 Fire No. S 82007
I, as:ULicensed Electrical Contractor ? Owner, do hereby request inspection of the above electri-
cal wiring installed at:
Street Address or Route No. 1222 Ea,st Baleam Trai 1 City Ea?an
Section , Township Range County Dakota
Which is occupied by Grea Dalhattg
(Name of Occuvant) Is a roughin inspection required on this job? No ? Yesim Ready Now ? Will Call$
PowerSupplier_ Dakota Ctv. Address Earmington
Electncal Contractor n R_ Thomneon F;7 actric Co Contractor's License NcA3396 2
(COmpany Name)
Mailing Address 19201 Mtka Bl vd,, %tka 55,3d2,
(Elecbical Contractor ar OwneuMaking This Installatlon)
AuthorizedSignature PhoneNo.
(Eletbical Contrectur$rOwner Making This Inslallatlon)
$VATE BOARD Thisinspectionrequestwilinotheaccepted6ythe
State Board unless praper inspection fee is enclosed.
Minnesota SW[e 9oartl of Elechicity
- Griggs Midway 61dg. - Room N791
?1BNUniversity Ave., St. Paul, Minp. 55704 - Phone 297-2111
`' REQUEST POR ELECTRICAL IIVSPECTiON
CHECK BELOW WOAK COVEREU BY THIS REQUEST
;;(1 Eg-0000 _OZ
S 82007
Type oteuilding New Add. Rep. Check Appliances Wired For Check Fquipment Wired For
Home ? ? ? Range ? iemporary Wiring 0
Duplex ? ? ? Watei Heater ? Lighting F'ixtuies ?
Apl. dld3. ?. ? ? Dryer ? Etec[ric Hea[ing ?
Commercial Bldg. ? ? ? Furnace ? Silo UNoader ?
Industrial Bldg. ? ? ? Air Conditioner ? Bulk Milk Tank ?
F'arm ? ? ? Lis[ ) ' t
Other ? ? ? Heh?ets}
f rs?
f
COMPUTE INSPECTION FEE BELOW I j\\ q?Temporary Servic e
ServiceEntranceSize: ;a Fee 1 1 FeedersflSubf ?W CIICUi[a: # Fee
0 ro 300 Am 0 to 30 Am er 0 to 30 Am eres
101 to 200 Amps. 31 to 100 Ampetes 31 [0 100 Am etes
Above 200_Amps. Above 100 Amps. A6ove 100 Amps.
Tcansformeis RemoteControtCirc: Partialorotherfee .50
Signs Special lnspection Minimum fee
Remarks Jeff D, TOTAL F „CX-' 8.50
I, the Electrical Inspector, hereby certify that the-above inspection has been ma e.
(Rough-in) ? Date
(Fir.al) ?.t.? Date
This request void l%
18 months from
3?{ SO?
Tf?st void /? ,Z 3; (i(l?,Q.cf ? C
18 months from ?
Date f s Request L'ire No. S 77540
I, as Licensed Electrical Contractor ? Owner, do hereby request inspection of the above electri-
cal ?Jfnc?g installed at:
Street Address or Route No. /2-? Z- L,91r
Section Township
Range County
Which is occupied by ?.??9•? ?,Yl *U
/ me of Occupant)
Is a roughin inspection required on this job? No ? Yes.PK Ready Now ? Will C,aK
PowerSupplierA9;rf,-J- "ef:tiL Address
o ?,q YGZSb ?
ElectricalContractor?1c;0x* ti?g ZZEContractor'sLicedseNo._
(COmpany Name) / Mailing Address . °t?Aq
(elec Ical controctor or owner Making This InsTallatlon)
Authorized Signature o?4 / Phone No. C1?3 `?Ys l
(Electrlcal Con' ractar 6r CMMM Making TNS Installatlon)
Sp? ?? -"C
?? L\ C[o This inspection request will not he accepted hy ffie
State Baard unless prnper inspection fee is enciosed.
MlmHresota State tloara ot Electricity
Griggs Midway 61dg. - Room N791 EB-00U01y02
Uhiversity Ave., St. Paul, Minn. 55104 - Phone 297-2117 ( ?? r
REQUEST FOR ELECTRICAL INSPECTION S 77 ?? ?V
CHECK BELOW WOAK COVERED BY Tff13?REQUEST
Type of Buiiding New Add. Rep. Check(? ppliances W'ved For Check Equipment Wired For
Home ? ? Aange Temporary Witing ?
Duplex ? ? Water Hexte[ ? Lighting Fixtures .?.t
Apt. Bldg. ? ? ? Dryer ? Clectric Heating ?
Commeroial Bldg. ? ? ? Fumace ? Silo Unloader ?
Industrial Bldg. ? ? ? Atr Conditioner ? Bulk Milk Tank ?
Patm ? ? ? Lis[ Lis[
Othex ? ? ? o
Heiersf ? Oehers?
H
COMPUTE INSPECTION FEE BELOW
Service En[rance Size: # Fee Fcedecs&Subfeedess: # Fee Cacuits: # Fce
0 to 300 Am s. 0 to 30 Am eres 0 to 30 Am eres O D.O
101 to 200 Am s. 10.00 31 to 100 Amperes 31 to 100 Am eres .( 00
Above 200_Amps. Above 100 Amps. Above 100 Amps.
Transformers RemoteControlCirc. Paztialorothetfee
Si ns eciallns ection Minimum fee
Remarks
TOTALFE 3 ,?i
I, the Electri c? Ins?to+?i '?'eb`y??tify that t? above in.spection has been m?
(Rough-in) /%:; DaiQ !/_pg-YU
(Final) ? - ? ?-- !D -fr I
This request void ?-
18 months from
*************???***********************
CITY OF EAGAN
CASHIER: JS TERMINAL NO: 729
DATE: 09/05/00 TIME: 10:22:09
ID:
NAME: MARK D KREY
3210 9001 1222 BALSM TR E 111.25
2155 9001 1222 BALSM TR E 2.50
Total Receipt Amount: 113.75
CR136840
USER ID: JAN
2000 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EACAN
3830 PILOT KNOB RD - 55122
651-681-4875 \
9-S-vU
New ConshucHon Reaulrerrfenia Rertwdel/Reoair Raaulremanb n 3 repiatered alte wrveys ahowing aq. fL of lot, aq. H. of house 2 coples of pian
and gu roofed areae (4096 maxlmum lof covemae allowotll 1 sel of energy calcWaHons for heated add(HOns
> 2 coplea of plans (show baam & wlndow sizes; poured fntl. deaign: ete.) t sita wrveY lor exlador adtliHOns 3 decks
a t set of enerpy calculaHau > 3 coplea d hee preaervaHon plan tt IW plaHed after 711/93
DATE: 1' 'c-9 v?? ONSTRUCTION COSf: "Yoc)
DESCRIPTION OF WORK:
STREET ADDRESS: L22= 2- E
LOT: BLOCK: SUBD./P.I.D. Y: tn t 8,0 v` .
Name: IS??,.? s 4? ,Jr&V\- T - Phone »: ( /Z - 3 --6 S-T 2
p(tppER7y Laaf Flnt
OWNER /
Sh6ef Address: / 2? Z- ? otS ti-?-. ?- -
Clty f c.e a-? Sfate: /v , 5 LP:
. Company: be-L. v ? Ca c _ Phone #: ? /-?- 36 s- 6E ?2
(area eode)
CONTRACTOR /
Sheet Addresa U-fr. h C?I `?/ lJcense # C??cp. '" ? d
City oe-J ?o State./-N Zip:
ARCHITECT/
ENGINEER Company: Name:
Telephone C ( )
Sheet Address: Regtshaflon Y:
City
State:
Sewedwater licensed plumbr (if InsWllina sawer/waterl: Phone A
I hereby acknowledqe Ihat I have read Ihis applkatbn, stale fhaf Ihe inlortnaiion is
of Mlnnesota Slalufes and Ciy of Eagan Ordinances. )? ,
Zip:
and agree b comply wHh all applicable Stafe
Signature of Applicanh
OFFICE USE QNLY
Certificates of Survey Received _ Yes _ Na
SEP 1 - 2000
Tree Preservat(on Plan Received - Yes - No - Not Required
OFFICE U5E ONLY
BUILDING PERMIT SUBTYPES
? 01 Foundation ? 07 05-plex O 13 16-Plex ? 21 Porch (3'sea•)
? 02 SF Dwelling ? 08 06-piex ? 17 Garage ? 22 PorchlAddn. (4-sea.)
plex ?
? 03 01 of 09 07-plex ? 18 Deck ? 23 Porch (screened)
_
? 04 02-plex ? 10 08-plex ? 19 Lower Level ? 24 Storm Damage
? 05 03-plex ? 11 10-plex Plbg _Y or _ N ? 25 Miscellaneous
? 06 04-plex ? 12 12-plex ? 20 Pool ? 30 ' Accessory Bldg.
WORK TYPE
? 31 New ? 36 Move Bidg. ? 43 Reroof
? 32 Addition ? 37 Demolish (Bldg)' ? 44 Siding
? 33 Alteration ? 38 Demolish (Interior) ? 45 Fire Repair
? 34 Repair ? 42 Demolish (Foundation) ? 46 WindowslDoors
' Give PCA handout to applicant for demolition permit
GENERAL INFORMATION
SAC Code # of 5tories sci• ft•
No. of Units Length 5q• ft•
No. of Buildings Width Footprint sq. ft.
Const. (Actual) Basement sq. ft. Census Code
(Allowable) Main level sq. ft. MC/ES System
UBC Occupancy sq. ft. City Water
Zoning sq. ft. Booster Pump
PRV
Fire Sprinklered
MISCELLANEOUS INSPECTIONS
? StuccalStone
APPROVALS
Planning Building Engineering Variance
? 31 Ext Alt - MuRi
? 33 Ext. Att - SF
? 36 MuRi
Permit Fee
Surcharge
Plan Review
License
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct: Deposit
S/W Permit
S1W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
? S C3
l l 3---I S
Valuation:
SAC Units
% SAC
6tAY'V"cY I'Gi` t
Greg Dalhaug •
, 12807 Dupont Ave. ?
Burnsville, Mn. 5 7
DELMAR H. SCHWANZ
ANOSURVEVOR
R. ' retl Untlar Laws o1 The State af Min.esota
2978- 1A5TH STREET .- BOX M ROSEMOUNT, MINNESOTA 55088
.-- 30
? - SURVEYOR'SCERTIFICATE
?j? ? ?S
PHONE 612 423-7769
? AA 9CALE: I INCH = 30 FEET
5?- 0 Denotes set wood hub
3a Q s foQ o Denotea iron pipe
--?'Utility
easement 2? qs
/
-?
Z ?
?
-
?
10%
?
d
c ?
w
N o5? s
1 P? ?aNs? i
?
,
.
?
?Z.c?"5 .
3??
N8?-S9- ?Sd? N78
I hereby certify that this 1a a true and correct repreaentation of
Lot 23, Block 1, WILDERNFSS RARK ADDITION, according to the recorded
plat thereof, Dakota County, Minnesota.
Also showing trie location of a proposed riouse as ataked thereon.
Dated: August 4, 1980
?
v
EXTBRIOR ENVELOFE AVERAGE "U" COP'IPUTATTOP?
OWNER
STTE ADDRESS / Z Z Z
CONTFiACTOR l/foS? DAT E f PHONE JE-?.s'S? 5
Determine ororking square footage of eaeh.
l. Total exposed wall area .... 2 09j-- $q. ft. x.1q =
2. fiotal roof/ceiling area ..../ 3 pS;" sq. ft. x. Uf- _, 3 z-
Total exposed wall 2rea above floor =/,pz/
a. Total wall windova area . . . . . . . . . . . . . . . . . 1?2,7 :3L
b. Total door area ................e....... iy, "
c. Tatal sliding glass area .............. . 2, ?t 2.
d. Total fireplace wall area ...... .. ....i/U,lrz?
e. Total wall framing area (average 10$)...??
f. Total net wall area above floor .........
g. Total rim ,joist area ................... . ?, i
Total exposed foundation area = O
h. Total foundation iiindow area .......... --
i. Total net foundation area above grade .-;, eo
Determine ",U" value of each wall segment.
a._?z7.t2 x "U': a,5-6- _ ' GS
b. X lrU:, .•3( ° ?,fS?
X "U •° .IS3' - 1?3.1?G
D .. X "U",
e. ,tL,7, X r:Urr Jj!=
f.J'y 9.e" X U,: .A6, _ ? ,?
9. X riui;
h. x "U°` 4i m
i. ZQp X F;us,
3 ............................................Tota1 = 3 7 2,j?
IF 2tem #3 is the same as, or less than item #1, you have met the
intent of SBC 6006(c)2.
'-_, w
Total exposed roof/ceiling area = r3o>>'
?. Total skylight area .. ....... ,.. ---^
k. Total roof/oeiling £raming area(average 10% 3e7.
1. Total net insulated roof/ceiling area ....... ii Gi
Determine "B! valtle for each roof/ceiling aegment.
? X vlUii
k. ./3 rl' .
1. //?1/ r.Ub .OL'S' ? 2c 7e
4 .........................................Tota1
If total of #4 is the same as, or less than h2, you have met the
intent of SBC 6006(c)1,
Alternate Building Envelope Design
To utilize the total envelope systen; method, the values established
by the sum of items #3 and #4 shall not be greater than the sum of
items #1 and #2.
1. 3 96','?s + 2• SZ, 3'L
3. .3 77,? + =
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA121109
Date Issued:03/13/2014
Permit Category:ePermit
Site Address: 1222 Balsam Tr E
Lot:023 Block: 001 Addition: Wilderness Park
PID:10-84250-01-230
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.
Diane Moyer
Home Energy Center
Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088
Surcharge-Fixed $5.00 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 -
Steven Jacobson
1222 Balsam Tr E
Eagan MN 55123
(612) 207-6641
Home Energy Center
2415 Annapolis Lane N #170
Plymouth MN 55441
(651) 766-6763
Applicant/Permitee: Signature Issued By: Signature