1366 Balsam St E? CITY OF EAGAN
` 3795 Pilot Knob Road Eagan, MN 55122 N2 4213
PHONE: 454-81 QO
; ;• ,
BUILDING PERMIT - -, Receipt #
t
To be used for Dote ?• 19 ?
Site Address ". 366 Erect Occupancy -;
Lot Block x Sec/Sub. Alter ? Zoning y
Parr-el # Repair ? Fire Zone _
Eniarge ? Typ2 of Const.
oc Name ? ` '`?' ' '? ' • Move ? # Stories
W
Z
o
Address 'r??
,
Demolish ?
Front it.
City Phone Grade ? Depth - ft.
? N Approvah Fees
o ame
?
?? Addre
? r...,
Name _
Address
I hereby acknowledge that I have reod this application and
the informotion is correct and agree to comply with ail
State of Minnesoto Stotutes ond City of Eagan Ordinanc
Signature of Perrnittee
A Building Permit is issued to: -
all work sfio44 be don3 in acsordonce w
Building Officipl
Assessment
Water & Sew. Permit
$urcharge `
Police
Fire Plan check
SAC
Eng. Woter Conn. - ? • ?? ?
Planner Water Meter ?
Cauncil
Bldg. Off.
'
APC Total ``'?
',
on the express condition thot
of Minnesota Stotutes and City of Easan Ordinonc<_s.
Ppmit # Date Issued POMktM
Plumbing
Mechanical
tNSPECTIOMS DATE INSP. RougFrln Firal
Footings bafe Insp. Dote Irup.
Foundotian Plumbing
Frome/ins. ? Mechanical
Final ?
Remarks:
CITY OF EAGAN
3795 Pifot Knob Road
Eagon, Minnesota 55122
Phone: 454-8100
PL(T1+I:3I'iG _ PERMIT No.
9, j i977 _•.;_.. ? ;?, ?-,
Date: Receipt No.:
Single I
Site Address: '??'6 E. Aa1S.' Residential •Lot Block ? Sub/Sec. Multi Res., Comm./Ind. I
Ncme ?..' rc? n;t , ro .
New/Alter./ Repai r
?
; Address Cost of Installation
O
?ity >_?.?omir.?ton phorke. Permit Fee 20, nn
.50
Nome
? Surcharge
?
Address
Q . ...._ , -.('`.. e
v •,.,La ?'? • ''? r i.ll yd
City Phone: ToYal
This Permit is iuued on the express condition thot all work shall be done in accordance with oll applicable Stote of
Minnesota Statutes and City of Eagon Ordinances.
Building Official -
CITY OF EAGAN
I' 8795 P" Knob Rood EagaA, MN 55122 N! 5070
PHONE: 454-8100
( hereby ocknowledge that I h
the information is rnrrect or
State of Minnesoto Stotutes
Signcture of Permittee -
A Building Permit is issued to;
oll work sholl be done in accc
Buitdinq Official
n?
Permit .
Surchcrge Plan check
SAC
Water Conn.
Woter Meter
on the express condition tfict
Minnesota Statutes and City of Eagan Ordinances.
vccupancy
Zoning
Fire Zone _
Type of Const.
# Stories
Front fi.
BUILDING PERMIT ReceiPr #
? F
Pemk # pate Isnad PwoMtw
Plumbing 7??
Mechonical
INSPECTIONS DATE INSP.
Rough-In
Fino!
Footings Dote Inap. Dots Insp.
Foundation Plumbing
Frame/ ins. Mechanical
Final
Remorks:
I, I r' 7 T c P a
CITY OF EAGAN
3795 Pilot Knob Road
Eogon, Minnesota 55122
Phone: 454-8100
-- PERMIT
Date:
Jmnk-uy 3, 1979
Site Address:
1366 Fast Halratn Trail
Lot ? Block Sub/Sec.
. _, a_:
No. 12f?7
lY. ., ,
Receipt No.:
Single
Residential
Multi Res., Comm./Ind. ?
Nome New/Alter./Repair
3 Address . Cost of Instollation -
?ln
City Phone: , Permit Fee
ame
? Surcharge
Address
0
[7
City Phone: I Total
This Permit is issued on the express condition that oll work shall be done in accordance with all applicable Stcte of
Minnesota Statutes ond City of Eogan Ordinances.
Building Official
?:.
IN
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
? SITE ADDRESS:
? ,,..
f Nt 1 (?t IrNt •?.
?+nt S nM r I
ir+IN ? 1 il
' PERMIT SUBTYPE:
I . ? I 1 f, 1?. ?' i? ri :, •
TION RECORD
PERMIT TYPE:
Permit Number:
Date Issued:
fill I 1 1,1 aIA
*zKi: 1
e7 >0 irs6
?? i ,,,?1 ? , APPLICANT:
?0 ? 61041K1
?t.i.•? ?., ? ?...•Fy
TYPE OF WORK:
z:I ., ; c; , 1 1;11
ta<kj I I i,
RF!'AtFt
cstn rMr,y
?
Pe?mit No. PermR Holder Date Tetephone A
ELECTRIC
PLUMBING
HVAC
Inspection Date Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
IMSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PL6G
FINAL HTG
ORSAT
TEST
BLDG FINAL d
?
BSMT R.I.
I
BSMT FINAL
DECK FfG
DECK FINAL
CITY OF EAGAN Remarks
Addition Wilderness Run Sth Addition Lot 10 Blk 1 Parcel 10 84354 100 01
Owner rna%<.f Lt,? Street 1366 E. Balsam State Eacran, MN 55123
Af?e :? _ 1 S?A?t l i Lf 'r i?ir , .i, ' Ci rJ
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK aa% 1973 132.60 $6.63 20 99.45 A003887 4-18-77
SEWERLATERAL
WATERMAIN
WATER LATERAL
WATER AREA 11/1 1977 160.00 10.66 15 149.34 A003887 -18-77
STORM SEW TRK 1981 2
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 220.00 2-28-77
BUILDING PER. #4213
sa,c 475.00 5361 -28-77
PARK
GTY OF EACiAN
3795•-Pilot Kwob Road
Eagan, MN 55142
Zoning:
Owner:
nAa,o«•
WATER SERVICE PERMIT
PERMfT NO.:
DATE: __
- No. of Units:
0 EI WR Stt:
Site Address:
Plumber: _
Meter No.:
Reader No.:
1 agree to eompFy with the Citp oF Eagan
Ordinantes.
By
Dote of Insp.
Connection Charge:
Acrnunt Deposit: _
Permit Fee:
$urcharge:
Misc. Charges: -
ToYol:
Dote Paid:
I nsp.._
CITY OF EAGAN
I 3795^Pilot Ithob Road
Eagon, MN 55122
Zoning:
Ow
ner. _ - -
Address:
Site Address:
Plumber. _
I agree to eomplr wifh the City of Engon
Ordinonees.
By -
Dote of Insp.:
SEWER SERVICE PERMIT
PERMIT NO_:
DATE:
No. of Units:
Connedion Charge:
Account Deposit: _
Permit Fee:
Surcharge:
Misc. Charges: -
Total:
Date Poid:
100. on ?
?-.? ..., _.
?iis request void 18 months from
?- - >•? R 5269
Date of this Request ?
I, as O Licensed Electrical Contractor Owner, do hereby request inspection of the above electri-
cal wiring installed at: ?I C. j?? I t?, -ytp-?
Street Address or Route No, f--'3 L' G'
Section Township
Which is occupied by
Is a roughin inspection required on this
Power Supplier,
?
Electrical Contr
Mailing Address
Authorized Sigr
NIN Il E
No ? Yes
(COmpany Nama)
Ready Now ? Will Call Er-'
Contractor's License No. _
? IectHCal Contracrof or Ownar Making Thls Installatlon)Jf-, ra ?
ittrt? ?K " Phone No. /z -!9_Z«
(Electrital Contr o of Owner Making ThIS Insiallation)
o?(%'?j /} ?D QO?? This inspecvon request will not be accepted by ffie
LUJ(,"ti1 Stata Board uniess praper inspection fee is enclosed.
• Minnesota State Board of Electricity
' 195d-University Ave., St. Paul, Minn. 55104-Phone 645-7703
REQUEST FOR ELECTRICAL INSPECTION
CHECK BELOW WOAK COVERED BY THIS REQUEST
R 5269
Type of BuAding New Add. Rep. Check Appliances Wved For Check Equipment Wrted Foc
Home ? lir D Range ? Tempoxary Wiiing ?
Duplex ? 0 ? Water Heatei D Ligh[ing Futures ?
Apt. Bldg. ? ? ? Dryet ? Electric Heating ?
Commexcial Bldg. ? ? ? Fumace Silo Unloade[ ?
Industrial Btdg. ? ? ? Air Conditionex Bulk MJk Tank ?
Farm List L
ist
Other ? ? ? p
Hehers? p
Heherg?
COMPUTE INSPECT[ON FEE BELOW.r-.
Secvice Enuance Size: # Fee Fcede tes: # Fee Cucuits: # Fee
0[0 100 Am s. 0[0 3" er Ks 0[0 30 Am eres /Lll
101 to 200 Amps. 31 to I res 31 to 100 Am etes
Above 200 Amps. Above 100 Amps. Above 100 Amps.
Transfo[mets RemoteConttolCtrc. Pattialorothexfee
S' ns Special Inspection Minimum tee $5.00
Remarks
TOTAL F ?
I, the Elec[rical Inspector, hereby certify that the above inspection has been ml?
(Rough-in) Date
(Final) Date
This request void 18 months from `
CITY OF EAGAN
3795 Pilot Knob Raad Eagan, MN 55724
PHONE: 4548100
BUILDING PERMIT APPLICATION $33,000.
?
N? 4213
Receipt #
7o be usea for Sing. Fam W. Garg. Dote Feb. 8? ,19=
$ite Address 1366 E- Ralsam _ Erect 7[] Occuponcy?
Lot 10 Block 1_ Sec/Sub. WR Sih _ Alter ? Zoning .
Porcel #
w Name _ Marell Const. Co.
3 Address_10800nLyndale Ave. So.
O ni__._
p Name _
t-
?u Address
r r:...
Nome _
Address
I hereby ocknowledge thot I hove reod this application and state thot
ihe information is correct and agree to comply with all opplicable
State of Minnesoto Statutes and ity of ga Ordi nce
Signature of Permittee
Repair ? Fire Zone _
Enlarge ? Type of Const. v
Move ? # Stories
Demolish ? Front ft.
Grade ? Depth ft.
Approvala Fees
Assessment _
Water 8 $ew.
Police -
Fire
Eng.
Planner _
Council _
Bldg. Off. -
APC -
Permit 70,uv _
Surchorge 16.50
Plon check
Snc 475.00
Woter Conn.?Z0,O0
Woter Meter --40"-W
Toral 809.50
A Building Permit is issued t¢ on the express condition that
oll work sholl be do m acc r?nce wjp1?9J}?a?pliwble State of Minnesota StaTUtes and City of Eagon Ordinonces.
.//3`, .
Building Official
`T
?._.._-
11J T3Li1' _07.bFG rERMTT dPPL'CR:IOId
??,?•
upTSLOCI? ? ADDITiO1S
°t'.I:CEL & 3r^^TOi.S '::Ji!P,;R 1^ ??iF.'•?aiTED ____._?__..
iaPiir,5e: ::P :?.'.RCrL-_7Z
UC?'J.?+Z'_v''C3 ?r USE----am?'t?SlL-1
° s^9 ,e ? ??..
O: iriS_:. TEI.?°t,??I?r iC0..__
r ili'03 ?C:G:LJ
r1111]'.l iCTvTi
mEr..EnFiorra iTO.
AS)litiRO5
YTOt!:s It;Clvcz,: plan, bui].ding plar.s, and energy C81Cllla.ti0:;3 :'1:4C:t: L}11S
appli.cction
Signed ----
OFPICE USE
i'AI,UAL•I0=_0;
?-
SAC
S92..i2:R COiTHIIEC:IO'tS
i4 :VER ?S: TER
BU:t.3:D'i:G FriV;-T r wE
,. ?F
PL:JY1 CZCi: F=
PP3RiZ D.:iJi!:zvnr,?:T FT'E
O'.Ciz^R
TOW.L*
f a:^.-'? ° p'.7 i? ?. S: )
AuuES:,"1'?:JT CLFMC ?f. . BUYLDIIQG DEPT. POLICS llC.^-T.
?_
??
?
T..1PaTPR & SLF?VR D3F"n. FI?2L TVPT, BZ112K DEI-IT.
CertiYicate For: • _
L'arell Inc. . 16600 Ibmdale pvP, go.
Bloor,icsgton, M3nn. 55402 Q Cert, #50
DELMAR H. SCHWANZ
LANOSUPVEYOR
Re9isterod Unaer laws of Tne State of Minntsota
14515 SOVTH ROBERT TRAIL P.O. BOX M ROSEMOUNT, MINNESOTA $5088 PMONE 812 423•7789
SURVEVOR'S CEHTIFICATE
- ,,
?LVLe' / -60
z ???`i 1?e '?r- t r
?
?` ?o'uru?y c?,a3
a ??I
? O
Joi7?. 6? X. l
r; o
N'di'?: 4?;
I hereby cerLify that this is a true and correct reoresenation oP LotJ6.
Rlock 1, PtIIAERNESS R.T.7 FIPTN ADDITION, Dakota County, Winnesota.
Also showing the location of a proposed house and garage thereon.
3-26-T6
f,
? MINNESOTA REGISTfiAT10N N0.8825 /
( ?
crrY oF R?"N
3795 Pilof Knob Raad Eagan, MN 55123
PHONE: 454-8700
BUILDING PERMIT APPLICATION
N° 5090
Receipt #' -! °? S?Z?
To be uced for F1ri15Y1 Ba.SHCl2ilt Est Value '] Date -11=28- --• 19-.-7g-
R
1
1366 E B u
onc
O I
d
S8I
Site Address
Erect
?
p
y
cc
Rl
10
WR 5th
1 Al Zoning ,
Sec/Sub.
Block
Lot ter 0 3
Parcel # 10 84354 100 Ol Repair ? Fire Zone V
Enlarge ? Type of Const.
Name Albert Z]SiI[eZI[k1T1 Move ? # Stories
rc
W
1366 E. B71SdiR
pemolish
D
Front
N•
1 Address
452-1196
Ed?fall Ph GfO? ? ?Pth . ff.
one
Ci
qpP„v,h
Fees
Name ?v RL11LOY'S
?? q?reu 44 So. 7tli St.
t- i-:«. Mpls ptione 341-3067
Name _
Hddreu
I hereby ackrwwtedqe th
ihe tnformation is mrre
State of Minnesota Smi
Signoture of Pertnittee
A Bullding Permit is issu
aIi vrork shall be doneir
Buildtrg Official _
stote that
appiicable
Assessment -
Water & Sew.
Police -
Fire
Eng.
Planner _
Council -
Bldg. Off. _
APG -
Permit c`'•""
Surcharge 3.50
Plon check
SAC
Water Conn.
Water MeMr
roeal 27.50
on the express condition ihct
Minnesota Statutes and City of Eagan Ordinances.
DATE
BUILD2NG PERMIT APPLICATION
Include 2 sets of plans, 1 site plan w/elevations and 1 set of energy calcuations.
To be used for Valuation
Site Address:
Lot Block Sec./Sub. /
? ?? ? • "? 'K_ s
Owner
) ?
Address-i-
Contractor
,
Address ,?-
Arch/Eng.
Address
Parcel Vumber
PO 8+3S'q- f? C? O I
Telephone ?-/- } v 1)cj L
Telephone ,3 1 )',? 6 (°-7
Telephane
OFFICE USE ONLY
Erect
Alter
Repair
Enlarge
Move
Demolish
Grade
Date of ADProval and Initial -
Assessment
Water/Sewer
Police
Fire
Engineer
Planner
Council
Bldg. Off.
A.P.C.
Occupancy
Zoning
Fire Zone ?
Type of Const.
$ of Stories
Front
Depth
Fees
Permit
Surcharge ?
Plan Check
' SAC
Water Connection
Water Meter
TOTAL
PERMIT
CITY OF EAGAN
3830 Pilot Knob Road PERMIT TYPE: B U I L D I N G
Eagan, MinneSOta 55122-1897 Permit Number: 029121
(612) 681-4675 Date Issued: 0 7/ 01 / 9 6
SITE ADDRESS:
1366 BALSAM ST E
LOT: 10 BLOCK: 1
WILDERNESS RUN 5TH
P.I.N.: 10-84354-100-01
DESCRIPTION:
(SIDING)
in.+g., Permit Type STORM OAMA6E
i'Building t?ork Type REPAIR
Census Cods -\ 434 ALT. RESIbENTIAL
r'*-'
?'.. K ,.
? A n rf < ?
?.' J? ...i ..
REMARKS:
FEE SUMMARY:
CONTRACTOR: - Applicant - S7. LIC.OWNER:
EXTERIOR DESSGN SERVICES 15713220 0003237 ZIMMERMAN COLLEEN
6391 MtlNROE ST NE 1366 BAL5AM ST E
FRIDLEY MN 55432 EAGRN MN
(612) 571-3220 (612)452-9066
I hereby acknawledgie that I haue read this application and state that the
information is corr''sct and agree tb- comply w1th al], applicab1s 5tate of, Mn.
Statutes and City of Eagan Ordinances.
APPLICANT/PEFMITEE SIGNATURE
..L? ?rt Im?
ISSU D BY: SIG TURE
' CITY OF EAGAN
lot" 3830 PILOT KNOB RD - 55122
1996 BUILDING PERMIT APPLICATION (RESIDENTIAL)
681-4675
New Construction Reauirements Re modeURenair Reauirem enis
? 3 registered s8e surveys ? 2 copies of plan
? 2 copiea of plans (include beam & window sizes; paured tnd. design; etc.) ? 2 site surveys (axterior additions 8 decks)
? 7 anergy calculations ? 1 energy calculations for heated addifions
? 3 copies af tree preservation plan N lot plaNed aRer 7/1/93
required: _ Yes
?D ? a No /
g- ? 1O
ST
7 a` O b Q
DATE: CONSTRU :
CTION CO
?
S+ S4O r
DESCRIPTION OF WORK: d i+'?
STREET ADDRESS: ?1 3(Q L ? (3 6 ?? 1-1-
?
BLOCK
LOT 10 IP
I
D
#: OJ
SUBD
? x ? RAIn - 6- U
_ .
.
.
.
-
-
Z?cAw,e.cK ?
N
Ob ((??--- (.s,?
#: z
Phone . -90(04?
- PROPERTY ame: -
X OWNER MT
Street Address- t3?U E! 3 aLs a w?
City: E' Ac "4,,,-- State: tM w Zip:
CONTRACTOR C Phone #:
x ompany:
6 3y? ????
Street Address: S'n- c
License #- y7
3a 3-7
City: State: ?'?n ?.... Zip. 2
ARCHITECT/ C Phone #:
ompany:
ENGINEER
Name: Registration #-
Street Address,
City: State: Zip :
Sewer 8 water licensed plumber:
change are requested once permit is issued.
Penalty applies when address change and lot
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.
Signature of Applicant:
OFFICE USE ONLY
.
Certificates of Survey Received _ Yes _ No
Tree Preservation Pian Received Yes No
BUILDING PERMIT TYPE
OFFICE USE ONLY
? 01 Foundation ? 06 Duplex ? 11 Apt./Lodging ?
? 02 SF Dwelling ? 07 4-piex ? 12 Multi Repair/Rem. ?
? 03 SF Addition o 08 8-plex ? 13 Garage/Accessory ?
? 04 SF Porch ? 09 12-plex ? 14 Fireplace o
? 05 SF Misc. ? 10 = plex ? 15 Deck
WORK TYPE
? 31 New ? 33 Alterations ? 36 Move
? 32 Addition ? 34 Repair ? 37 Demolition
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Pianning
? "f? ?' • A4
1i?m? ir ,, ...:.
16 Basement Finish
17 Swim Pool
20 Public Facility
21 Miscellaneous
Basement sq. ft. MGWS System
Main level sq. ft. City Water
sq. ft. Fire Sprinklered
sq. ft. PRV
sq. ft. Booster Pump
sq. ft. Census Code.
Footprint sq. ft. SAC Code
_ Census Bldg
Census Unit
Building 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.
Road Unit
Park Ded.
Trails Ded.
Other
Copies
Total:
Valuation: $
°k SAC
SAC Units
53 -3I q RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651•681-4675
New ConsW ction ReaulremeMs
• 3 registered site surveys sMVdng sq. R of lot, sq. R. of house; and all roofed areas
(ZO% mavimum lol caverage allowed)
• 2 copies of plan showing beam & window s¢es; poured found design, etc.)
• 1 set o( Energy CalcWations
• 3 copies of 7ree PreseNation Plan if lot plalted after 711193
• Rim Joist DeWil Options selection sheef (bldgs with 3 or less uniLS)
DATE 7- i 9- oa
?
3600 -
RemodellRemir Reauirements ?
• 2 copies ot plan
• i set of Energy Calculations far heated additions
• 1 site survey for exterior additions 8 deCks
• Indicate if home Served by sepfic system for additions
VALUATION
SITE ADDRESS &,54 l.? I S c?tivc? S? MULTI-fAMILY BLDG
Y N
_ _
TYPE OF WORK_)Z,e_ rc ?o E fIREPLACE(S) _ 0_ 1 _ 2
APPLICANT
STREET ADDRESS / ,,dg CITY?STATE/?/1 ZIP-5---?azlL?
TELEPHONE # 95?1 ? g14 ,Aa6?CELL ONE # 99':,) -a70 • 71 9 ? FAX #
v
PROPERTYOWNER TELEPHONE#CzS?J-5`S?- 90?'cs
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MIVNESOTA RULES 7670 CATEGORY 1 MINNESOTA RUL1iS 7672
(d submission type) . Residential Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Envelope Calwlations Submitled
Plumbing Contractor: _
Plumbing system includes:
Mechanical Conhactor.
Mechanical system includes:
Sewer/Water Contractor:
_ Air Conclitioning
_ Heat Recovery System
Phone #
Phone #
Fee: $70.00
-°---------------------------------°---°--° °----°---°----°--°--------------°°----------------------------------
I hereby acknowledge that i have read this application, state that ihe information is correct, and agre comply
with all applicable State of Minnesota Statutes and City of Eagan Ordin ?ces.
Slgnature of Appllcant
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4l02
Water Softener
Water Heater
_ No. of Baths
_ Phone #
Lawn Sprinkler
No. of R.I. Baths
?r
?
?r t
Fee: $90.00
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA171609
Date Issued:08/24/2021
Permit Category:ePermit
Site Address: 1366 Balsam St E
Lot:010 Block: 001 Addition: Wilderness Run 5th
PID:10-84354-01-100
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Standard Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Fee Summary:PL - Permit Fee (WS &/or WH)$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 -
Hp Minnesota I Llc
120 Riverside Plz S Ste 2000
Chicago IL 60606
(612) 827-7951
Tim's Quality Plumbing/a Aarts Quality Plumbing
225 County Road 81
Maple Grove MN 55369
(651) 454-1010
Applicant/Permitee: Signature Issued By: Signature
