808 Ivy Lane
Werfificate nf cccupanc?
W" of Cfagan
??? ? Smishis 3*60ectim
This Certificate issued pursuont to the nequiremerets of the Uniform Buildeng Code
certifying that at t1u tirae of usrrance this structure was in complirmce with the various
ordinartces of 1he City regulating breilding construction or use. For the following:
Use Clusification: DLTP= Bldg. Plermit No. ,g 1Q
OavpancY 7ype R3 I 7?aio6 Disuid PD Type Coost. VN
Owoer of Buildiog WOOM•?? ??M HMS Addrtss 6648 B[]$TTC RD SE, MQZ LW
, ?, D?.'' ?? ??
?ity
717, Ad?ess 1AW ?
Dam 05/18/q3
?^, euiwrig`offickil POST IN A CONSPICUOUS PLACE
?
4CITY OF EAGAN
3830 Pilot Knob Road
Eapan, Minnesota 55123
.C-J'CORD
PERMIT TYPE:
Permit Number:
Date Issued:
SITE ADDRESS: t n
Ittt ?,?ui?1?1 AN1?', Nuit 1 It
PERMIT SUBTYPE:
„11. I ,
APPLICANT:
1! 1i:traiw1 - :,!.j , i
t6 1 .'1 1147 2 4,14
TYPE OF WORK:
INSPECTION .. . .,
I- MliRh'1.. REt"f'.7i'1 a
C 021817
iF
& W CC?N7RAf. 1 oR Cif.. N'• FYAN PI Hr
--1
1
PermR No. Permft FFolda Dats TeleQhone #
S!W
PLUMBING
HVAC
ELECTRIC. e'?,?9
ELECTRIC
Inapectlon Date Insp. Comments
F??ingsi
11IfI4z
Foundation
Freming
Roofing
Rwo Plbg- 40 d4 y-? 9 n
Rough Htg. _ _ f?
Freplace
??y93
z?-?
Flnal Htg. -127-21
Orsat Test
Rnel Plbg. 17 Plbg. Inspector - Notify Plumber
Const. Meter
EngrJPlan
&dg. Fnal s I
Deck Ftg.
Deck Final
Well
Pr. Disp. • ?'
2g 93 ?? ?
d ti07 591
REQUEST FOR ELECTRICAL INSPECTION
? Sea msVUCUOns lor campletmg IDis lortn on pack oi yellow capy
"X" Below Work Covered by This Request
BM?^yPa EB-00001-08
ew A ? ?--TypeofBUildinq AppliancesWued EquipmentWireO
Home Range Temporary Service
Duplez Weter Heater Eleciric Heating
Apt Building Dryer Other_(Specity)
Comm.llndustrial Furnace
Farm Air COndRioner
Olher(spectly) CanVa<ror5 Femarks
Compute /nspection Fee Be/ow•
u Otnar Fee # ServiceENrenceSize Fee # CrtcmtslFeeders Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers Above 200 _ Amps _ Amps
Signs Inspecmr6 usa only TOTAL ?Q
Irngation Booms ?? ?
Speciallnspection
Alarm/Communication THIS INSTALLATION MAV BE OR B' ISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 78 S.
I, the Electrical Inspector, hereby Ro.ymm oej
certify that the above inspechon has
been made. Final
/
OFFICE USE ONLY
TM1is rBpvesiMitl 18 montM1Silom
d 7 91
Repu ,Xate'r;: ? Fire N. Rough-in Inspedion
R
tl'+ (
(7+N8rNObty Inspeaor
? Featly Now
a-a - eqwre
? ea 7 No .
Wnen Featly+
Iz wiCensed contractor :1 owner hereby request inspection of above electrical work at:
Job Address (Slreet Boe ar Roule No ) B ? n Ciry
??sti ?V
Section No Township Name ar Na Ran e Na Coun
OccpaN RINT(!rGIr<yN'w"'"`
l PhoneNo
PowerSuppher
' Atltlress
i
Electnc I Conlrector
fCOmpany Na ) tCc1r,-,r'sliCense No
Mailmg Aetlress (G nVactor or Owner Making Install2lion)
AW?on ignalure iCOnvactov/p? wner Ma'k/in?g Inslla?p?q?
. .NL? . P/hone; Number /
!]w --& -3
MINNESOTA STATE BOAPD OF ELECTRICITYV ? THIS INSPECTIDN REQUEST WILL NOT
Griggs-Mitlway BIEg. - Foom 5-073 BE FCCEPTEO 8Y THE STATE 80AR0
1821 Oniversny Ave, $I. Paul. MN 55106 l1NLESS PROPER INSPECTION FEE IS
Phone(6fl) 6,12-0800 ENCLOSED
Address 808 In r.arE Zip 5512 3
, , .
Lot 5 Blk 3 Sub Tm t,rooDiarms rroxiH
THESE ITEMS WERE / WERE NOT WMPLETE AT THE TIME OF THE FINAL INSPECTION.
Date: OS/ 18/93 Yes No Inspec[or.
Final grade (6" from siding)
Permanent steps (gatage)
Permanent steps (main entry) Vl*'
Permanent driveway
Permanent gas
?
Sod/Seeded grass
TraiUcurb damage ?
Porch ?
Basement finish
Deck ?
Please verify with the builder the removal of roof test caps from the plumbing syslem and the shut-off of water supply to
the ou4side lawn faucet before freeze potential exists. Contact engineering division at 681-4645 before working in rightof-way or installing undetground sprinkler system. ?
White - City Copy Yellow - Resident Capy Pink - Contracror Copy
2422 Entr.rprise Drive
y? PIONEER LIINDSURVEYOR3•CIVILENGINEERS Mendota Ileights, MN 55120
J
? englneerinry• LANOPI.ANNERS•L1INUSCAPE IIRCHITECtS (612) 681 1914
Certiticate of Survey for. W00ULAND COUlY T!C_Y!?OMES,1lK ?
? NORTN
V? ?
ti
"r? 9 3??z „
?g4.7j S W
N ?
,
/{^r IA
?N Q
0 0 v' ?C
o
l? / ? o?s ?._•.,.i' t?
SQ F
N TO N 10
?o ? "Y 1 H
o ?'?'?c ?p W
/ Hv m T3? MmM? O ? O
O O
s,
\? ?o ti%,e S J8 I 2
B?6•3 I N8
?ar
/ I
4;r2 E \
^?
I Q
M ?v
By • __.. w
Da'e
r: ??AN ENG;NZ.F_xtrs`l
?
?v
w
> 9oU.o Dwotes Exislin £levaiion ? Praopos£v HousE EGEVQ o
r 070-0
Ueno>es Prnpo?ed Eleva/ion Lowes loor Fleva ion
-------- Denofes brrrina e i Ufili.ly £asemenf Top o,' Block I-lPVa>i on
--- •--- Denoles DrrinQe F/oWDireclion GarU0t Slab Elevafim 89 •
o Denoles Monuffivnl BeariIs shown ar•e nssumfd oDei?0es ojTjFhe Tbb
LOTS 5 ANa 6,BLOClI 3, TNE VIIODDLANDS IIORTH
DAKOra CbUNTV , M?NNf50Tq ' SUBJECT TO fySEMENTS Of QECt9RD
1 hrrrby certily ihaf thia is a true and corrPCl irpreeentntion nl a turvry nf Ihe M1nundnirc n11hr abnv? rl?? In v1 nl tho Ioralinn o( all
hullAinqs, therPOn, and alt visible encroachment5, il nny, frnm or rn, said Imrd. As ainveyed by mr rhis?.'y or -n.n. M.W.
Scale : IX,L?
_________ ___ RORF I R SIKi?I 1.`. qf t) 1?997
?to3s, 03 - ---
, LOT BIIRVEY CSEC1[LIST FOA REBIDENTIAL
? BOILDING PBRMIT IiPPLICIITS
PROPERTY LECiALS
Date o! survop: z?-
CIIMENT ¦T71N1
RD
/ 9
A
Er
A ? : Registered Land Surveyor signature and company
0
? Building Permit Applicant
Q
?- /0 • Leqal description
0 [?' ?
? • Address
?? 0 • North arrow and bar scale
fY 0 0 • House type (rambler, walkout, eplit w/o, split entry,
6'0 0 lookout, etc.)
• Directional drainage arrows with slope/qradient !.
0?0 • Proposed/existinq sewer and vater services
D' ? • Street name
0 0 • Driveway
L"LEVATIONS
Existina
D 0
'/? • Sewer service
-
-?/C?" 0 • Lot corners
H' 0? • Top of curb at the driveway
0? 0 • Elevations of any existing adjacent homes
ProDOSed
? 0 • Garage floor
? First floor
? : Lowest exposed elevation (walkout/window)
?
F . Property corners
? • Front and rear of home at the foundation
PONDING AREAB (if applicable)
0 B/Q • Ea
ement line
0"
/
• ?
L
0 6
? • HwL
0 C? • Pond # desiqnation
D B 0 • Emergency Overflow Elevation
rurarawv?aia?a
l9" 0 0 • Lot lines
??0 • Right-of-way and street width (to back of curb)
[q" 0 0 • Proposed home dimensions iacluding any proposed decks,
overhangs greater than 21, porches, etc. (i.e. all
? structures requiring permanent footings)
L9" ?? • Show all easements of record and any City utilities within
those easements
0? • Setbacks of proposed structure and setback of adjacent
existing homes
D 0 • Retaining ??ements, if any
- Reviewed: 7
OCtober 1992
. . PERMIT
' CITY OF EAGAN
3830 Pilot Knob Road PERMIT TYPE: s u r. Lo r n G
Eagan, Minnesota 55123 Permit Number. 003 g i g
(612) 681-4675 Date Issued: 11 J 30 119 2
SITE ADDRESS:
808 rvv LANe
10T: 5 BLOCK: 3
lii? W000LRI'dC7S NOR7H
P.I.hI.:
DESCRIPTION:
Buildi-ag PermiT Type DUPLEX
SuiJd.ing'Warl• typ? N?61
' UBC Occupancy H-3 Ivi--.l.
Consi.rucrion Type V-p!
Zoriinq Pti
618
BuiLdirig Width ? 34
REMARKS:
ftCr- r.Fr it c 021817 S f w r.DNrruar.rnR - CEfdz-RYaN PLRG
FEE SUMMARY:
VALUATTON
t '; s .. F I, e
1' 123f1 RFV1bW
Siarchai qe
Si`C ?
SF:C Units
Suhrnt"l
I.ss0 e00
$383 .50
;4a.so,
i,J?nrn ?) 0'
1 0 0
1
q,89,F+08
mrsrFl.L A iv[ nu:? :?t c1a,.?o
lota 1. Fe e $3.328.50
CONTRACTOR: - F?nn,t.ie?nt -- si , t-.CrOWNER:
S"LEKM flfVP4 I:OttST 1,147717+1 0001436 Wf70(71.F,M6 COUP!T'FZYHOhIF5 TNC
6 5h8 ftUSI'IC ti[7 _;E 5648 RUST7C RD SE
PP,SOft LkiKE Mnl 55372 PRfOf•; LHKE MN
41 /-2 111; 7.4 4 7-2 ?11-1 4
I Iioreby acknowiedye ChaT. "t have reaci Thi^> application and state that T.he
infinrmuT.ion .is correct and agrre io comp7,y w3,'rh a1.1 applicab.le State crf iln.
Stat_utes and City o'f Eagasi Ordinanres? -
? nrln R o1? I 11',,d
APPLICANT/PERMITEESIGNATURE "?- I SUEDY V LGNATURE
PERMIi #
RtRCTIUATE
A 19
CITY OF EAGAN 1313:?'?. F?
1892 BUILDING PERMIT APPLICATION
681-4675
SINGCE & MULTI-FAMILY 2 sets af plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of architectural & structural plans, 1 set of
specifications, 1 copy of energy calcs.
Penalty applies when typing of permlt is requested, but not picked up by last working day
of month in Mhich re uest is made r tat chan e is re uested once ermit is issued.
Date Nov. ? 16 / 92 Valuation of work $$$,180.40
Site Address: 808xji*#xyjsjgg 808 Ivy Lane
STREET SUITE A
Tenant Name: (cammercial only)
LoT 5_ BLOCK 3 SUBn.The Woodlands Nort P.I.D. 0 10 75890 050 03
Descri tion af work:
The applicant is: O Owner L?] Contractor ? Otll@I' (Deseribe)
Name Woodland CountryHomes, Inc. ? Phot1e447-2424
Property LAST F,RST
Owner
Address 6648 Rustic Road S.E.
STREE7 STE N
City Prior Lake State MN ZiP 55712
Company Siekmann Construction, Inc. Phone 447-2424
Contractor Address 6648 Rustic Road S.E. License # 0001436 EXP.3/31/93
City Prin LakP State MN Zip 55372
Company Phone
Architect/
Engtneer Na"'e Registration #
Address
City State Zip
Sewer 6 water licensed plumber Genz-Ryan Plumbing , Processing time for
sewer & water permits is two days once area as een approved.
I hereby acknowledge that I have read this application and state that the information is
correct and agree to comply ' h all applicable State of Minnesota 5tatutes and City of
Eagan Ordinances.
Signature of Applicant: ? ?
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation
? 03 SF Addition
O 04 SF Porch
? 05 SF Misc.
WORK TYPE
10 31 New
? 32 Addition
9 u
4-Plex
? OS 8-Plex
? 09 12-Plex
? 10 Multi. Add'1.
? 33 Alterations
? 34 Repair
? 11 Apt./Lodging
O 12 Multi. MisC.
O 13 Garage/Accessory
? 14 Fireplace
? 15 Deck
O 35 Tenant Finish
O 36 Move
GENERAL INFORMATION
Const. (Actual) y.n/
(Allowable) v-a
UBC Occupancy C'3 M-I
Zoning Pp
/ af Stories
Length ?
Depth c?
APPROVALS
Planning
Engineering
REQUIRED INSPECTIONS
? 5ite
0 Nallboard
Basement sq. ft.
lst F1. sq. ft.
2nd F1. sq. ft.
Sq. Ft. total
Footprint Sq. ft.
On-site well
On-site sewage
Building L Lz
Variance
.
? Footing
? Final
? Framing
? Draintile
O Insulation
? Fireplace
Permit Fee
Surcharge
Plan Review
License
MWCC SAC
City SAC
Nater Conn.
Mater Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
Valuetion:
8 89ODa
. . ?, -
13 I5 Cseufent Finish
? 17 Swim Pool
0 18 Corren./Ind.
? 19 Comm./Ind. Misc.
? 20 Public Facility
11 21 Miscellaneous
? 37 Demolish
MWCC System ` ES
City Water YES
PRV Required
Booster Pump
Fire Sprinkler
Census Code ipZ
SAC Code ?L
c?en,su? b?d? . ?
C&nStsB a""0
Assessments
SAC % /Dfl
SAC Units I
EXTERIOR ENVELOPE AVERAGE "U" COMPUTATION
owrvER: WOODLAND COiJNTRYHOMES, INC.
SITF AIIDRFSC• Le-? 1:z fSLo1 aE 3 hlnnirnt_e?nc IV/(m-Yl/ aunniF•
CONTRACTOR: SIEKMANN CONSTRUCTION INC. - LIC. #0001436 DATE:
DETERMINE WORKING SQUARE FOOTAGE OF EACH:
1. TOTAL EXPOSED WALL AREA .............. 976.00 sq ft x"U" 0.710 = 107.36
2. TOTAL ROOF/CEILING AREA :................ 7,435.00 sq ft x"U" 0.026 =?37.31
3. TOTAL EXPOSED WALL AREA CALCULATIONS:
Total exposed wall area above floor........ 976.00 sq ft
al Total window area:
Double glazed ........... ............. 171.00 sq ft x"U" 0.430 47.73
sq ft x "U"
sq ft x "U"
61 Total door area :.................................... 38.00 sq ft x"U" 0.070 = 2.66
c) Total sliding door area:
Double glazed ........... ............. 40.00 sq ft x"U" 0.430 = 77.20
glazed ........... .............
d) Total fireplace wall area :.......................
- 0:00
- 0.00
sq ft x"U" 0.370 = 0.00
el Total wall framing area
(AVERAGE 10%).......... 97.60 sq ft x"U" 0.095 = 9.27
f) Total net wall area
above floor (insulated) ........................... 689.40 sq ft x"U" 0.043 = 29.64
g) Total rim joist area :............................... NA sq ft x"U" 0.034 = 0.00
Total foundation area (exposed)............
sq ft
h) Total foundation window area .. ............. NA sq ft x"U" 0.430 = 0.00
i) Total net foundation area a6ove grade...., 0.00 sq ft x"U" 0.045 = 0.00
3. Total ai thru i) 106.51 I
If item #3 is the same as, or less than item #1 you have met the intent of 2 MCAR 1.16008 A and 0.
Page -1-
: ? .
4. TOTAL EXPOSED ROOF/CEILING CALCULATIONS:
Total exposed roof/ceiling area . ............. 1,435.00 sq ft
j) Total skylight area ................... ............. 0.00 sq ft x"U" = 0.00
Total roof/ceiling framing area
k) (Average 10% ............. 143.50 sq ft x"U" 0.039 = 5.60
d) Total net insulated
roof/ceiling area .................................... 1,291.50 sq ft x"U" 0.024 = 31.00
4. Total a) thru i) 36.59
If item ll4 is the same as, or less than item #2 you have met the intent of 2 MCAR 1.16008 A and 0.
ALTERNATE BUILDING ENVELOPE DESIGN
To utilize the total evelope system method, the values established by the sum of Items #3 and Itam tf4
shall not be greater than the sum of Items #1 and it2.
1. 107.36 + 2 37.31 = 144.67
1 106.57 + 4 36.59 = 143.10
CERTIFICATION
I hereby certify that I have calculated the "U" factors and "R" values herein and that the building here
in described meets or exceeds the state of Minnesota Energy Conservation Act.
(signaNre)
(Dale)
Page -2-
PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. AL50, FOR TOWNHOMES AND
CONDOS WHEN PERMITS ARE .REQUIRED FOR EACH UNTf.
NO. FIXTURES EACH TOTAL
? SI€Q:*.'Eit 3.00 -7lJ v
? WR,TER CLOSET 3.00 (?c-r CJ
? BATH TUB 3.00 ? a U
LAVATORY 3.00 ? /l U
KTTCHEN SINK 3.00 ? o d
? LAUNDRY TRAY 3.00 _? o v
HOT TUB/SPA 3.00
WATER HEATER 3.00 20 O
? FLOOR DRAIN 3.00 z o v
GAS PIPING OUTLET •?? • ? 3.00 .:?d d
! ROUGH OPENINGS 1.50 / S V
WATER SOFTENER 5.00
PP.IVAT'E BISP. • DeLuy. ii, 15.00
U.G. SPRINKLER • nome unaa ?L 3.00
ALTERAT'IONS • to ?ting 15.00
WATER TURN AROUND 15.00
STI'E
OWNER
STATE SURCHARGE .50
TOTAL: CJ?J
STATE: 2?7/.Y1 ZII' CODE:??) G 0
PHONE #: ( ) 9?K 2-3 -- /l cl?K
PLUMBING PERMIT (RESIDENI7AL)
CITY OF EAGAN L07" --?' S
3830 PILOT KNOB RD ?lL_&t,X.g 3
EAGAN MN 55122
(612) 6814675
? ???? f
,
L g s 3 ?c?g.a,rncaFi r x M xECEm # o? U9'
SUBD. fi?N ( j) , (612) 681-4675 DATE 3
/!o
RFSIDIIVT'IAL
PLEASE COMPLETE UPPER PORTION ONLY FO;t SIIVGLE FAMIIY DWELLINGS. ALSO, COMPLEI'E FOR
TORNHOMESlCONDOS WHIIV SEPARATE PERMIIS ARE REQUIRID FOR EACH DWELLING i7NIT.
OWNER: C-_C5vNA-r FEES
SITE ADDRFSS ADD ON/REMODEL (EXISTIIVG
CONSTRUCTION ONM $ 15.00
INSTALLER: AVAC: 9-100 M BTU 24.00
PHONE #: ?O 2, c? ADDITIONAL SO M BTU 6.00
ADDRFSS: GAS OUTT,E7'S - MWIMUM 1@ S3 EA. 3• d
crnr: C=?„?„ Q_ zH?: suRCanRCE: a.so
SIGNA TOTAL: $ a,R •?,6
COMMERCIAL
PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAIJINDUSIRIAL BUILDINGS. ALSO COMPLEfE FOR
APARTMENT BUILDINGS OR OTHER MULTI-FAMILY BUII.DINGS R'AEN SEPARATE PERMITS ARE NOT REQUIRED FOR
EACH DWELLING UNTf.
R'ORK DESCRIPI'ION:
CONTRACf PRICE I FEFS
196 OF CONTRACf FEE. ?
STATE SURCAARGE IS $SO FOR EACH
$1,000 OF PERMIT FEE $
PROCFSSED PIPING - $25.00 F
MII?iII1iUM FEE - S?•?
?? ?g2- 2004 RESIDENTIAL BUILDING PERMIT APPLICATION
City OfEagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New ConsWcfion Reauirements RemodellReoairReauiremenls
3 registered site surveys showing sq, fl, of lot, sq. N. of house; and all roofed areas 2 copies of plan
(20% maximum lot coverage allowetl) 1 setof Energy Calculations for heated additlons
2 oopies of plan showing beam 8 window sizes; poured found design, etc. 1 site survey for addilions 8 decks
1 sel of Energy Calculahons Add'rtion - mdicafe 'rf ortsife septic system
3 copies of Tree Preservation Plan d lot platted afler 711193
Rim Joist Detail Op6ons selecGOn sheet (bldgs wiN 3 or less umts
OtficeUse`onl
Ced6CSurvgyRea(.? --- Y =11
7're8 Pes PI?fiReW ' t1
TraePrC,SReuired, ?.,Yy
bnsif:'SejiB'cSysJem_ N
Date
Y
SiteAddress Construction Cost
lv -j ?l UniUSte #
Description of Work l e I/'nc ;r? cr J:[ ? 1 C L???V
Multi-Family Bldg ? Y _ N Fireplace(s) y/ 0 _ 1 _ 2
Property Owner W60-91 4in ,j C?vvI-N /=J ??^^C S Telephone # ( )
Contractor f-el U"^FJkS ? 4,-A?6c5-
Address d ni
State L ?? ?, ( ? ? {1 • City
Zip Telephone # 32g? ?
COMPLETE THIS AREA ONLY IF
Energy Code Category Minnesota Rules 7670 Cateeorv 1 _
. Residential Ventila6on Category 1 Worksheet
(J submission type) Submitted
. Energy Envelope CalculaGOns Submitted
Have you previously constructed a building in Eagan with a similar plan2 _ Y
fee applies.
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone #(
Telephone # (
N If so, 25% plan review
Telephone #( Q) v H " ?
I hereby apply for a Residential Building Permit and acknowledge that the informat on is complete and acc rate;
that the wark will be in conformance with the ordinances and codes of the City o 43 1VIN
Statutes; 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.
A NEW BUILDING
Mmnesota Rules 7672
• New Energy Code Worksheel
Submitted
Ii1ct tr iU L?v11 4tiS4-i1 /;I
ApplicanYs Printed Name Applicant's Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA169438
Date Issued:05/26/2021
Permit Category:ePermit
Site Address: 808 Ivy Lane
Lot:5 Block: 03 Addition: The Woodlands North
PID:10-75890-03-050
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507)
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 -
Patrick & Deborah Byrne
808 Ivy Ln
Eagan MN 55123
Schwantes Heating
6080 Oren Ave N
Stillwater MN 55082
(651) 439-3331
Applicant/Permitee: Signature Issued By: Signature