874 Govern Cir _ . v _ _ _
~ _
Address 874 Govern Circle
Lot 7 Blk 3
THESE 1TEMS WERE / WERE NOT COMPLETE AT TEE TIME OF THE FINAL INSPECI'ION.
Date: -7 -.;2 - -?'7 z Yes o Inspector:
Final grade (6" from siding)
Pertnanent steps (gazage)
Permanent steps (main entry)
Per[ttanent driveway
Pennanent gas
Sod/Seeded grass
TraiUcurb damage
Porch
Basement finish
Deck
Please verify with the builder the removal of roof test caps from the plumbing system and the shutoff of water supply to
the outside lawn faucet before freeze potential exists.
Contac[ engineering division at 6614645 befote working in rightof-way or installing underground sprinkler system. ?
` White - City Copy Yellow - Resident Copy Pink - Conlracwr Copy
Zip 5512 3
$llb Gardenwood Ponds 2nd
7,?.J 1 7 . I . 3
3 regi ed sde suneys
(20% 'mum bl coa
1 S111 lep 'rf propose
2 oapies of pW ovnng
1 set of Energy C ulafi
3 copies of Tree P2 rv
Rim Jo?st Detail OpUOn
00
2007 RESIDENTIAL BUILDING PERMIT APPLICATION /30
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
?nts RemodeVReoair-Reauirements Office Use OnN
:howing sq ft. of lol, sq. ft of house; and all roofed areas 2 mpies M plan shmving foo4ngs, bearns, jdsis Cert M SuNey Recd :rage allowed} 1 set M Energy Calculations for heated atldNi
Sails RepoA
1 building is W be placed on disNNed soil 1 site survey for addifions & decks Tree Pres Plan Recd
beam & window sizes; poured fowd desyn, e1c. Addflion - ind?'cafe d on-sife septic syste Tree Pres Required '
On-siteSepfi9Sysiem
Plan'rf lot plaked after 711193
6on sheet (buildings wib 3 or less unBs)
.. . ? --??--- ---?--- --??
Y N
Y N
_Y _N,
_Y _N
_Y _N
r
C "Ad q
?rn 4r?eln CP!`I'PI' AYt('I tIl _ ?_9SOYI.
rians are cvnslu VCU 4YIYb IIIIVII??PVV?? u
Date ? I 3 k 1 -7 ? st?u ionCost
Site Address tj C, I 2eLr ? UniUSte #
Description of Work . 5 c-,)?-os c+?
Multi-Family Bldg J Y y/N Fir lace(s) _ a _Z1
SGO Telephone#(
ri O
PropertyOwner
Contractor o s
E
?
Address oZ 3 v <<-6a v.^ . -?o rw« c
City I
?-!
State Zip SS y Telephone #(?JS-
c r4 a?c a-?3c?
COMPLETE THI AREA ONLY IF CONSTRUC G A NEW BUILDING
innesota Rules 7670 Cate o 1 Minnesota Rules 7672
Energy Code Category , Residential Ventilation Category 1 Worksheet ? New Energy Code Worksheet
(Jsuhmissiantype) Submitted Submitted
. Ener9y Envelope Calculations Submitled
In ihe last 12 months, has t e City of Eagan issued a permit for a similar plan based on a moster n8
_ Y _ N If yes, date and address of masier plan:
Licensed Plumber Telephone #( ?
? , ?, '?l ?? l-E,- I
Mechanical Cont actor Telephone #( )
Sewer/WaterC ntractor In A1.1G 3 1 ZaQ7 Telephone#( J
I hereby apply for a Residential Building Permit and acknowledge that the information is completebnd accurate;
that the work will be in conformance wit6 the ordinances and codes of the City of Eagan and the 5tate of MN
3tatutes; 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
41 proval of plans ?
Applicant's Printed Name ApplicartYs Signature
,
?,. r.
Sub Tvpes
? 01 Foundation ? 07 OS-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
?K 02 SF Dwelling ? OS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 EM. Alt - Multi
? 03 01 of_plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn (4-sea.) ? 33 EXt.AIt - SF
? 04 02-pfex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebolpergola) ? 36 Multi Misc.
? 05 03-plex ? 17 10.pfex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex ? 25 Miscellaneous
Wo rk Npes ?If
¢r
?
? 31 New 35
?] Int Improvement ? 38 Demoli5h Interior ? 44 5iding
? 32 Addition / ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
?
33 Alteration
? 37
Demolish Building• ?
43 Reroof ? 46
WinddwslDoors
? 34 Replacement 'Demolidon (EnOre Bldg) • Give PCA handout to appliwnt
DO NOT WRITE BELOW TT3IS LINE
DeSCfIpYl011: Water Damage _ Yes
i 20'?
Valuat
on J
Plan Review 100% or 25%
Census Code t/1.
SAC Units
# of Units
# of Bldgs
Type of Const v
Occupancy .??.
MCES System
Zoning
Stories
Sq. Ft.
Length
Width
City Water
Booster Pump
PRV
Fire Sprinklered
_ Footings (new bldg)
Footings (deck)
_ Footings (addition)
Foundation
Drain Tile
Roof Ice&Water Final
? Framing
_ Fireplace _ R.I. _ Air Test _ Final
_ Insulation
REQUIRED INSPECTIONS
_ Sheetrock
Fina]/C.O.
? Final/No C.O.
HVAC
Other
Pool Ftgs _ AidGas Tests Final
_ Siding _ Stucco Lath _ Stone Lath _Brick
Windows
_ Retaining Wall
Approved By: 1:L , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
Cify SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
/5? nr
????
?q')' A ?
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EACAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-881-4675
New Construction Reouiremnh
• 3 registered siM surveys showirg sq. R. of lat, sq. N. of houu; and all roofed areas
(20%masimum lot coverage allaxed)
. 2 copies of plan showing 6eam & window srzes; poured found design, etc.)
. 1 set ot Energy Calculations
• 3 cropies ot Tree Preservatian Plan if lot platted aNer 7/1l93
. Rim Joist DeUil Op6ons selectbn sheet (61dgs wiih 3 or less unils)
DATE 7`3 '6 Z
RemodellReoairRealuirements ? ry? ? •
. 2 copies ol plan U
• i set of Energy Calculations for heated addifions
• 1 sile survey for extenor addilions & decks
. Indicate R home served 6y sepUC sysMm for additbns
VALUATION
?
SITE ADDRESS 87 !V Go v9E1W C JP • MULTI-FAMILY BLDG _ Y _ N
TYPE OF WORKa -Ro 0 F FIREPLACE(5) _ 0_ 1 _ 2
APPLICANT ale-ogir- a A,-a J 1
STREETADDRESS ' tjT D CITYjjEN&rtor STATEMrv ZIP$S3Y/.
TELEPHONE #9X??4YY •50e3f CELL PHONE # FAX # 441 -ly4- /SbI/
PROPERTYOWNER SCeTI' 7e,,e¢,vg TELEPHONE#GSl^3I0-B0S 1
---------------------------------------------------------------- -------------------------------
COMPLETE THIS SECTION FOR "NEW" RE5IDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RULLS 7670 CATEGORY I MINNrSOT;I RUI.ES 7672
(Jsubmission lWe) • Residen6ai Ventilation Category i Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Envelope Calculations Su6mitted
Plumbing CoMractor: Phone
Plumbing syslem includes: Water 5offener _ Lawn Spnnklcr Fee: $90.00
Water Heater No. of' R.I. Baths
No. of Baths
Mechanical Contractor: Phone #
Mcchanical system includcs: Air Condilioning Fcc: $70.00
_ Heat Recovery System
I _
Sewer/Water Contractor. .-.-___ Phone #
-------------_-----------------------------•- - ---------- _ AUG-.Q__7_2DI12--
I hereby acknowledge that I have read this application, state that the information is corr and agree to com
with all applicable State of Minnesota Statutes and City of Eagan Ordinances:
Signature of Applfcanf
OPrICE IJSI? ONLY
Certificates of Survey Received _ Tree Preservation Plan Received Not Required _
Updated 4/02
CT.TY r)f EA{;;o1N
CAiH:I:GR„ r; 7F.:1='MI:IVAi... Np: bGB
nf.'!Ec 04I29/99 TIMF_: 0::909
TD.
NAi1E; U Fe tlO(iTON 'CNf.;
2:IL;5 9001 8'r'4 GOl!ETiN !"TF; 99.,00
2252 E}L'.?(:) e74 GO'Jir`'tN t-IF; 30.0.0
3741 1220 074 GQV"c"I"tN C.1:6; 50.00
377; 3220 ti74 f;OVE.RN GIFi 59,.00
386p, 9a379 274 r;OV;::Rid .r.,].R t0mE7Q
3716 9220 874 GOV1i"Fpl rTft i:.4.t]o
^',£iE:ci 9220 874 G(",VE!';:N f:Ili FrbB.CU
W:, 9220 R?4 !;CIVE:Rn! C:Ch f405,,00
2422 9001 874. rti!A=:Rt! clh 91314.02
2275 9220 974 GqVFi.ttiN C.I.Fti 1y039.5(7
Cf?!.D"7,.',.1.3 *?t f;0i?1'F.AlU_
US+-R zD: Nancv Mt c:ONt:[tat,E
Y:Y,::'t)Yww1 , wri::',:Y,CaW Y;:.. ,;';CX;r,•:i>XM%fw;;'>nfP =*? .i?
.,.,rk?t7;tiY%?ip!i?iMY,:iXY,:;?:?:Y,:?::.7;t:;?<X:;kk.+.i:$?:?;o'•„ CONf'rNUE:
!]S'iY GF Er1f;AN
CASHSf::T-:: ':ii 7F..:ht^1.T.NAA. N0; 66$
LArE: 04i2„9,?99 T:f.NiE: 1509:50
r1i.
NFli1F':i 1.' R I-IOFi'i'Op.1 1NC;
:344b 9001 ^oi4 C(liJ[::IiN f.;fR 10,.50
3"r::Lt] 9001 874 GOVIiRP! I.:7'R l1ci.^-,6.,95
'in.`.a] Rereip` Aric,7unt.: };,'j;?_tsi
01CI"r".'i 1.3
USf::6; Ill: NANCY
!:7;YdY(•Y,Sm7'F???Y,tY,(YF>'?YFJ;CY,4Y;: , r""r'?t;<.7'n'%Km,'iY;"nt:,F'?i(Y,t>,:Y,;7;t%?m
??
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
?
+ CITY OF EAGAN
3830 PILOT KNOB RD - 55122
(651) 681-4675 n p,
New Construction Reqmrements Remodel/Repair Reauvements
? 3 registered site surveys
? 2 copies of plans (inGude beam & window sizes; poured fnd. design; etc.)
? 1 energy calculations
? 3 copies of tree preservation plan if bt platted aker 7!1/93
required: _Yes _ No
DATE: 'T' I-s- cI ?Y
? 2 copies of plan
? 1 site surveys (exterior additions & decks)
? 1 energy calculations for heated additions
CONSTRUCTION COST,A[I52?
DESCRIPTION OF WORK: ????k\(?C:?XnUI
STREET ADDRESS:
LOT: BLOCK: J SUBD./P.I.D.#: C7c"t-A-nGUbl--.X
PROPERTY
OWNllt ? ? ?„ _. • / ? c ' ? ?_ a
Srreet
c[n -- ----- 1::?? stace: _- fjjN----- zip: 55 12 -1
------ - ---------
L--- Yhone k: ---------------------?
cov'ritAcrox
S[reet Acldress:___???un r tx. G'.-SIrceiise # ---------Lsp. .
Cily Statc: ---------- Zlp" -------- -
ARCHITECT/ 1 /Iy? a-? ZL?
ENGINEER Coinpany:_?lQ-?(1L -------------- Yhoiie H: ??L=-----------
ReRnsUhlion N:
titree[ Address:=c7? ?ci_`_--------------------
City --?GI`? ?'--------- - Sta[e: ---- -- Gip'
Sewer & water licensed plumber (new construction only): ?f \AJ cSr_? . Penalty applies when address
change and lot change is requested once permit is issued. (' `a I-I s--±, 43 8-3
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicabte
State of Minnesota Statutes and City of Eagan Ordinances.
, Signature of ApplicanL LIIZ4Z
?
OFFICE USE ONLY
Certificates of Survey Received t Yes _ No
Tree Preservation Plan Received - Yes - No
L ?
SLot Required
? ??
OFFICE USE ONLY If
BUILDING PERMIT TYPE
? 01
4 Foundation ? 06 Duplex
02 SF Dwelling ? 07 4-piex
? 03 SF Addition ? 08 8-plex
? 04 SF Porch ? 09 12-plex
? 05 SF Misc. ? 10 _-plex
WORK TYPE
A 31 New ? 33 Alterations
? 32 Addition ? 34 Repair
? 11 Apt./Lodging ? 16 Basement Finish
? 12 Multi Repair/Rem. ? 17 Swim Pool
? 13 Garage/Accessory ? 20 Public Facility
? 14 Fireplace ? 21 Miscellaneous
? 15 Deck
? 36 Move
? 37 Demolition
GENERAL INFORMATION ,
Const. (Actual) 5- nf Basement sq. ft. I'-? °1 I Census Code 16 I
(Allowable) S- r.l Main level sq. ft. 1L-( ,?l 1 SAC Code
UBC Occupancy Q' 3 2`D L%/ sq. ft. I-5 3'S Census Units
Zoning CZ • I Ar2 , sq. ft. b?. Census Bldg
# of Stories 2- sq. ft. MC/WS System
Length lo'I sq. ft. City Water
Width 516 Footprint sq. ft. Booster Pump
PRV
Fire Sprinklered
APPROVALS
Planning Buil ding Engineering Variance
Permit Fee Valuation: $ ? Gl 7, b00 ?-
Surcharge
Plan Review t??1 I Jt 1s. - 22 , 3L5--
License
MC/WS SAC
t w,
s 4
Bo ? 511 4 ?
CitySAC 1S33x Y4 ? Bz,"78
Water Conn.
Water Meter
6l04x ?
Acct. Deposit
SNV Permit
S/W Surcharge *L- ef (o ?? °-6
?
Treatment Pi.
Park Ded.
Traiis Ded.
Other
Copies
Total:
% SAC
SAC Units
' I1 ,sl.
ENCRGX CODPIWORKSHEET POR 1& 2 F2IMSLX DWELLINGS
sz^rs-?,uasss Go?Go'?,]p!` ??E'?! ?';i? •. ?
CITY
COBpLETED BYf_y,IC,. `?IL1?ON?? ?'_ pIIONB N?? 1OATL
BUILDIt7G CLA9SIFICATIOt7t' CI categoiy'1 (nttltidard) or ik-category S(muot includa vontilation)
HZt7IMUH CRITEAIA
?
Foundation Ineulation-R1? F7alln k Wi mdowo , Roof Attia lnaulation,
(See slab on Grade Ineulaeion-R10 forallowable percentages) R44-With Attic No 1[eel
Flovr over unheated epacea-1124 R30-With Attic Raised Ileel
Foundation Windowe 1/2"
insulated Glase h3B & RS-Solid Rafte're
, .
-Wood or Vinyl Prame
'STBP 1 Wladow & Door Area STBP ] Calculate area se a peroent of Wall
A. Total Window & Door Area in aq. Feet
WINOOWS (Tncluding Foundation Windowo) : HINDOW,HAINFACTURE NAMIIS C. From Step 1 divide box A(Y7indow & poox
h'ZL7DOW MAiNPIlCTORS TYP6r Area) by box b(total wall area) timao loo
fY equale the window nnd door area es a
I WI27DOW MA1tDPACTUI(Q V YACTOAf i percent of wall area (box C).
, R. O, Quanl-ity oq.EL'.AYea ?_ X 100
bimeneione, ?oK 13 ? a C a
Zt"?'PNX ""? u ""? ? ?? ? STEP 3 Deplgri Peaturap
? `pN x ASSEMBLY
4`vNX??h ? //?f PRAMING TYPEt
z?, N?, `? I?
! I? STnP1DARD FRNIINO' ?otude 16^ o.c.
?" QN xt3 "o? ADVANCED FRItMZNO ntude 24" o.c.'
_VN x ?eµ CAVISY INSULATION ?
2`?V XJu" 9fISAT1SIIIG TYP6i
X LESS T13AN < R-5 _X_
x R-5 > oR tiOAE
X U-FACTOR p
???'u From t}ie table, (reverae eida) determine the
maximum percent window & door area for.tha
B dcaign optiona solocted and entor tha t valtie
x? in Box D below baeed on tha window mfg. U-
? W Eac[or:
?X??--,; ? ? -
D
7'otal Area of Ii= Q( ..pq,Et. _
,Htndows &; Doore ' -
8. Total Wall Area in Sq. FC. The t value from tlle Lnble in Uox D eliail ba
equnl to or greaCOr than t6o } jn Dox C
Wall Total Ileiglit Araa
Yerimeter :
Z7 v .
51 570
v ro.?7
v .?-
7bta1 Area of M7alls peq.[t
.'
- - > -.
ONE- & TWp_p/?mILY RCSiDCNML pU(MTNg pRESCRfpl.NE (COOK-tioOK)
AF'1'ROAQI
MAXIMUM WINDOW AND bOQR AREA AS A PERCGNT OF OVERALL WALL
AREA
"sim_txltnn._livite nar! 7670 ^al?,?y??? f? item x
Cavit Exterior Window U-Factor
F...,.1..? . _ . .. _ .
STANDARD j? 1J
R-13 zR - 7 13.49'e 1778 % 21.39'0 24.3%
,
Sl'ANDARD
R-15 R- 5 12.4% 16.4°a I9.7°a 22.5`Yo
STANDARD
ii-18
19 > R- 5 12.9°?fo
' 17.1% 20,1%v 23.4Yo
STA?VDARp -
R-18_19 <[t - 5
R- 5 12.19
e
1 16_0% ]B.8°fu $2,pa,
ADVANCED
R-78-19 4.0% 18.6% 21.8% 25.3yo
C[L - 5 12.9% 17
1°a 20
19' '
ADVANCED
I?-18 . .
e 23.4
0
-?g Z R- 5 14.59'0 14.2'Yo 22
5q, 26
1%
STANDARU
STANDARD R-21
R-21 < li - 5 12.0% 17.09'0 .
19.9% .
23.1%
ALIVAp
R-21 >?- 5 14.5% 19.3% 22.5% 26.1%
R-21 < ft- 5 13.6% 18.1% 21.2% 24.6%
R- 5 lS.OY. 19.9% 23.29'0 26.9%
f?dEtlanal ts,l? ??? ?yy;? Notea:
Window eres equals rough opening tninus lnotallallon clearancee.
Window U-(actor musl b-c determtnad by elther tht Nalional Fenestratlon Rating
Councll etandard 100-91, or ASEiRAE 1993 Handbook of Fundamentals, Chapler 27,
Ta61e 5.
R
LOT SURVEY CHECKLIST FOR RESIDENTIAL
BUILDING PERMIT APPUCATION
PROPERTYLEGAL
U
? N
a >
a =
? a d
¢ z° 2
? ? •
? .
c •
?y?
Fa' ? ? •
? c •
?a ? .
? ?.
?
?? ^
':I ?
DATE OF SURVEY
LATEST REVISION:
DOCUMENTSTANDARDS
Registered Land Surveyor signature and company
Bwlding Permit Applicant
Legaldescription
Address
North arrow and scale
House type (rambler, walkout, spfit wlo, splR entry, lookout, etc.)
Directianal dreinage arrows with slopeJgradient °k
Propased/ebsfing sewer and water services & inveR elevation
Street name
Driveway
Lot Square Footage
Lot Coverage
ELEVATIONS
Ecistina
• Sewer service (or Proposed)
• Property comers
• Top of curt at the driveway
• Elevations of any ebsEng adjacent homes
? Prooosed
6 y ? • Garagefloor
rf ? ? • First floor
y?? ? • Lowest e?osed elevation (walkoufhnindow)
? ? • Property comers
P-o ? • Front and rear of home at the foundaUon
PONDING AREA (if aodicable)
? 5--?o • Easement line
? rra . NWL
? HWL
? q/o • Pond # designation
? ? • Emergency Overflow Elevadon
?
pIMENSIONS
cr?o ? • Lot IineslBearings 8 dmensions
e' ?? • Right-ot-way and street width (to back ot curb)
o"a ? • Proposed home dmensiorre indudmg any proposed dectcs, overhangs greater than 2', porches, etc.
? . (i.e. aA structures requiring permanerd Tootings)
? ? Show all easements ot record and any City uU6des within those easements
7 ? • Setbacks ot proposed structure and sideyard s?ack of adjacent epsGng structures
e' ?
a rT ? . Retaining waA requirements, N any /
Reviewed:
March 19BB
caA1G1&0avar.rrFlw
CITY USE ONLY
L BL ? RECEIPT#: OO / ?"?
SUBD. RECEIPT DATE: `?//
PERMIT# ?7"7C)
1999 PLUMBINfi PERMIT (RESIDE1vTIAL)
CIT]' OF EAfiAN
3$30 PILOT KN09 RD
£k6AN, MN 5512E
(651)681-4675
Please complete for: > single family dwellings
D townhomes and condos when permits are required for each unit
% backflow preventer for underground sprinkler system
FIXTURES
EACH # TOTAL
Bath tub $ 3.00 x = 31
?
Floor drain 3.00 x
Gas i in outl2t ' minimum - 1
3.00
x
= $4
5
6
Hot tub/s a 3.00 x W
Kitchen sink 3.00 x 0
Laundr tra 3.00 x
Lavato 3.00 x
Minimum fee alterations to existin dwellin 30.00 x
Private Dis osal S stem new/refurbished ' re uires MPC iic. 75.00 x = $
Private Dis osal S stem abandonment 30.00 x = $
RPZ new installationlre air 30.00 x = $
Rou h o enin 1.50 x ,3 = $ 5
Shower 3.00 x = $ °d
Under round s rinkler if dwellin is under construction 3.00 x = $
Under round s rinkler if existin dwellin 30.00 x = $
Water closet 3.00 x = $ °
Water heater 3.00 x = $ °
Water soft2ner if dwellin under conslruction 5.00 x = $
Water softener if existin dwellin 30.00 x = $
Water turnaround 30.00 x ---- = $
State Surchar e .50 --> ----> ----> $ .50
Total --> --? ----> ----> $ 53.°
Reminder. Call for inspections of alterations, i.e. water heaters, water softeners, etc.
------------------------- --- --- -------------- ------ •-------- --- --- -- -------------------- -------- --- ---------------------------- - ------
I here6y acknowledge that I have read this application, state that the informaUon is correct, and agree to comply with all applicable City of Eagan ordinances.
It is the applicanPS responsibility to notiTy the property owner that the City of Eagan assumes no liability for any damages caused by the City during its
normal operational and maintenance acLvities to ihe facildies constructed under this permit within City property/right-of-way/easement.
SITEADDRESS: n-14 aov n ? 0?
OWNERNAME:: TELEPHONE#: tAREA E
INSTALLER NAME: - kla Qn TELEPHONE #: CQs `-+olJ
ARE ODE)
STREET ADDRESS: ? L-I _] ?j ?e-:]p \nhQ IZj
cirY: g05)2YYi0 u?r14 STATE: YYI N ziP: SSU(??
SIGNATURE OF PERMITTEE
CITY USE ONLY
LOT ? BL RECEIPT #: /O c/G?S
SUBD. RECEIPT DATE:
? MECHANICAL PERMIT
1999 MECHANlCAL PERMIT QRE.SIDMIaoEL)
crrY oF EAeeuu
3$30 PILOT KNOB RD n?V
EAfiRN MN 557E2 Olir/
,,^ ? f65U 6$1-4675 rj
Date: /??
Complete this section only if you are installing HVAC in a single family dwelling, townhome or condo under
construction and not owner /occuoied.
• HVAC: 0-]00 M B T U
ADDITIONAL 50 M BTU
• Gas outlets (minimum of one required @$3.00 ea.)
State Surcharge
Totai
$ 30.00
6.00
? (o, a0
.?u
Complete this section onlv if you aze 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 Alteration Repair _ Other
Reminder: Ca11681-4675forinspections.
_ Furnace _ Air conditioning
_ Air exchang,=.r _ C[her
$ 30.00
State Surchazge .50
Minimum Total Due $ 30.50
SITE ADDRESS: 874 6Yey U `?/ `?"r/ n
? ?
So? M i Ll,e2 ? ?,{ ?r
OWNERNAME: SFAD?? ?E?SI1?"L PHONEt?: G?S/ - LI'J`t' `t4,63
INSTALLERNAME: (?3nl?'NALEPC? a-4) °vG PHONE#: ACO?S
(AREA CODE)
STREET ADDRESS:,,I a L C? E-PCM1'i OAJ-e-
CITY: F?Pj2MiJJ6 " STATE: !'I/J ZIP:
174,
?
SIGNATURE COF PERMITTEE
CITY
8L ? USE ONLY
RECEIPT #:
i,)sN7 430•5,0
SUBD. 4ardiNWO6 NON S Z? RECEIPTDATE: ? 'OC)
PERMIT #
2000 PLUMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT IINOH RD
EAGAN, PIII 55122
651-681-4675
Please complete for: ? single family dwellings
? townhomes and condos when permits are required for each unit
? backflow preventer for underground sprinkler system
FIXTIIRES
FeIru a
TAT A t
Alterations to existing dwellir?g - minimum fee
Describe: ?0 l4't' ? lP 6'e ? _ $ 30.00
Bath tub $ 3.00 x = $
Floor drain 3.00 x = $
Gas pipin outlet ` minimum - 1 3.00 x = $
Hot tub/s a 3.00 x = $
Kitchen sink 3.00 x = $
Laundry tray 3.00 x = $
Lavatory 3.00 x $
Septic System newrrerurbisned ' requlres MPC lic. 75.00 x = g
Septic S stem abandonment 30.00 x = $
RPZ new installation/repaidre6uild 30.00 x = $
Rough opening 1.50 x = $
Shower 3.00 x $
Undergrounds rinkler ifdwellin9isunderconswaion 3.00 x = $
Underground sprinkler If existing dwelling 30.00 x = $
Water closet 3.00 x $
Water heater 3.00 x = $
Water softener if dwelling under construetion 5.00 x = $
Water softener H existlng dwelling 30.00 X = $
Waterturnaround 30.00 x $
State Surchar e .50 -> -> -> $ .50
rotal _> _, $ 301 U
Reminder: Call for inspections of alterations, i.e. water heaters, water softeners, etc.
I hareb aclcnowled e tliat I have 2ad tFiis a lication, stete thet the infovnation is correct, and a? ree to com
Y 9 PP g ply with sll epplicable City of Eagen ordinances.
It is the applicant's responsibility to notify the property owner that the Ciry of Eagan assumes no Iiabitity for any damages pused by the City during its
normal operational and maintenance activities to the facllitles constructed under this permit within Clly propertyMght-of-way/easement.
StTE ADDRESS: ? 77 6'aY?'2sV C?i/ZC ZE Z:?96Ail/-M/V- S-S?d 7
OWNERNAME:: `/DE ??TH7JL.EiP TELEPHONE#: 6,.57/' a769
(AREA CODE)
INSTALLER NAME: lY. I 1' TELEPHONE #:
STREETADDRESS:
cirv:
(AREA CODE)
STATE: ZI P:
SIGNATURE OF PERMITTEE
*********?**********??***?*************
CITY OF EAGAN
CASHIER: JS TERMINAL NO: 014
DATE: 04/12/00 TIME: 10:44:59
ID:
NAME: SHELLER OR JOSEPH STADLER
3212 9001 874 GOVERN CIR 30.00
2155 9001 874 GOVERN CIR 0.50
3210 9001 874 GOVERN CIR 60.00
2155 9001 874 GOVERN CIR 0.50
Total Receipt Amount: 91.00
CR125989
USER ID: JAN
??x:r**?****:r***?a****t x:t?:tt**???*:tt*:r:rt
2000 BUILDING PERMIT APPLICATION (RESIDENTIAL) ;D
CITY OF EACAN
3830 PILOT KNOB RD • 55122 Called 4(10100
851-887-4675 OW
New ConshucXOn Reaulremenh Rertrodel/Recdr Reauiremenh
D 3 repidered qte wneys ahowlrg sq. ft d bf, tq ft. of house 2 copiea ot plan
anC 4!! rooletl areas t2QX mmdmum lot eovemae allowetl) 1 sel ot enerpy oaieWaHons tor heafetl atlditlona
D 2 copies of Wans (kww beam A wlndow d:4K Paretl fnd. dealyn: etc.) 1 fife wrvey /Or extedor addiMOm a decka
D 1 lef ot 6neryy CalcWatlont '
> J copies d hea preservallon plan H lof pkftd ofter 7/1/93
DA1E: ff 171iJ 0 CONSTRUCTION COST: ?v?4,Gbo, vo
DESCRIPTION OF WORK: /"-/N/,S? 3,q.SEM N i
STREET ADDRESS: __ F7y 70 ?/e.P6fi/
> r
LOT: ? BLOCK: k-?' SUBD./P.I.D. #: nrdP i i i1raDd rC H=s 7 ?1
PROPERTY
OWNER
COMRACTOR
ARCHITECT/
ENGINEER
Name: ?TA2)GeR -5'3 Phone #:
Lasf Flral
Sfreet Address: ? 7y ?O?/E,eiil CiiC'L' LC
CnY F?9 ?JN State: N!/1/ ZIp:
Company: J Z ??,? Phone g:
(area code)
Slreet Address: License # Exp.
CI1y
srote:
Lp:
Company: Name:
Teiepnone #: (
Sheei
Cily
SMfe: Lp:
Sewerlwater liCensed plumber (if Installina sewar/xrater): Ptanelk:
I herebY acknowtedpe ihaf I have read this application, alafe i1w1 Me Infomqiion Is cortecf. and agree to compy wNh atl app6cable Sfiate
of Minnesolc Slafufes and City of Eapan Ordinancea
' Signahire o( AppiicanY. ?(• ? .13?7 ????l.c. ?
I
OFFICE U5E ONLY
Regishafbn i:
Certificates of Survey Received _ Yes _ No ' ;; j. T ?
Tree Preservation Pian Received _ Yes _ No _ Not Required NyvN
OFFICE USE ONLY
BUILDING PERMIT SUBTYPES
p 01 Foundation ? 07 OS-plex ? 13 16-plex O 21 Porch (3-sea.)
? 02 SF Dweliing p 08 06-plex ? 17 Garage O 22 Porch/Addn. (4-sea.)
O 03 01 of _ plex ? 09 07-plex O 18 Deck O 23 Porch (screened)
? 04 02-plex ? 10 08-plex ,!T, 19 Lower Level ? 24 Stortn Damage
O OS 03-plex ? 11 10-plex Piog Y or _ N O 25 Miscellaneous
O 06 04-plex ? 12 12-plex O 20 Pool O 30 ' Accessory Bldg.
WORK TYPE
p 31 New ? 36 Move Bidg. ? 43 Reroof
? 32 Addition ? 37 Demoiish (Bldg)• ? 44 Siding
33 Alteration O 38 Demoiish (Interior) O 45 Fire Repair
? 34 Repair ? 42 Demolish (Foundation) ? 46 Windows/Doors
' Give PCA handout to appl icant for demolition permit
GENERALINFORMAT?
SAC Code
No. of Units
No. of Buildings
Const. (Actual) A/
(Allowable) ??
UBC Occupancy
Zoning
# of Stories
Length
Width
Basement sq. ft.
Main level sq. ft.
sq.ft.
sq.ft.
MISCELLANEOUS INSPECTIONS
O Stucco/Stone
APPROVALS
Planning Building f A ? Engineering
sq.ft.
sq.ft.
Footprint sq. ft.
Census Code
MC/ES System
City Water
Booster Pump
PRV
Fire Sprinklered
Variance
O 31 Ect. Alt - MulU
O 33 Ext. Alt - SF
0 36 Muki
?- c
Permit Fee Valuation: $?
Surcnarge
Plan Review
License
MC/ES 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 Units
% SAC
***********?***************************
CITY OF EAGAN
CASHIER: JS TERMINAL NO: 672
DATE: 09/01/00 TIME: 07:00:26
ID:
NAME: SHELLY A STADLER
3210 9001 874 GOVERN CIR
3430 9001 874 GOVERN CIR
2155 9001 874 GOVERN CIR
Total Receipt Amount:
CR136798
USER ID: JAN
60.00
1.00
0.50
61.50
2000 BUILDING PERMIT APPLICATION (RESIDENTIALI
CIT? oF ??G? 4 b l. 50
?z 6I ? 3830 PILOT KNOB RD - 55122
651-6814875
New CornfiucHan Reaulremenh RemodeVReoalr Reauiremenh
> 3 regisfered slte wrveya showiny W.1L ol lot, sq. H. of houae 2 copies ol plan
antl Qy roofetl areas t20% mmdmm tot coveraae atlowem 1 set ol energy cdculaHOns 1or heated atldflHOns
> 2 coples of plana (ahow beam At wlncbw al:es; poured tnd. tleslgn; etc.) 1 sife wrvey tor extedor addlHOns 8 decka
> 1 set of energy catculaMoru
> J capies o1 tree PfefervaMOn Plan K lot PbMetl ofter 7/1/93
DATE: S?O?O CONSTRUCTION COST: OOO
DESCRIPTIONOFWORK: ?fICK Y,9RD ./7?ek
STREET ADDRESS: F 77 0 D t/16-4 /? C' /
LOT: -7-BLOCK: v SUBD./P.I.D. t: ar
(w) eoia - 3a/-5 70s
PROPERTY
OWNER
CONTRACTOR
ARCHITECT/
ENGINEER
Name: STi417L ee zF Phone lf:
Loa Flot
Street Addreas: S?y G'OdnPN ??2 CG.t
cNy ?? 'AN stare: /V/1/. np: SS/? 3
Company. J? 1 t^ Phone #:
(area code)
Sheet Address: license # ExP•
Ciy
State:
Zip:
Company: Name:
Telephone 9: (
Sheet Address: ReglshaHon Y:
CNy
Sfafe:
Lp:
Sewedwater licensed plumber (if Installina sawer er): Phone #:
I hereby acknowledge lhat 1 have read this applicaHon, ske tne? me tnroRnanon b coRecr, and agree fo eomply wilh a0 appOcable State
of Minnesofa Stafutes and City of Eagan Ordinancea
Signalure of AppUcanh
OFFICE USE ONLY
Certificates of Survey Received _
Tree Preservatlon Plan Received _
Yes _ No
Yes - No - Not Required
?1-PC-1Z'71VE1)
AUG 3 0 2000
?v. ?
OFFICE USE ONLY
BUILDING PERMIT SUBTYPES
? 01 Foundation O 07 05-plex ? 13 16plex ? 21 Porch (3-sea.)
? 02 SF Dwelling ? 08 06-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.)
? 03 01 of _ plex ? 09 07-plex OP 18 Deck ? 23 Pcrch (scraen?d)
? 04 02-plex ? 10 08-plex ? 19 Lower Level ? 24 Stortn Damage
? 05 03-piex 0 11 10-plex Plbg _Y or _ N ? 25 Miscellaneous
? 06 04-plex ? 12 12-plex ? 20 Pool O 30 Accessory Bldg.
WORK TYPE
d 31 New ? 36 Move Bidg. ? 43 Reroof
? 32 Addition ? 37 Demolish (Bldg)' ? 44 Siding
? 33 Alteration ? 38 Demolish (Interior) ? 45 Fire Repair
? 34 Repair O 42 Demolish (Foundation) ? 46 Windows/Doors
• Give PCA handout to appl icant for demolition permit
GENERAL INFORMATtON
SAC Code D /
No. of Units _t
No. of Buildings ?
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
W idth
Basement sq. ft.
Main level sq. ft.
sq.ft.
sq.ft.
MISCELLANEOUS INSPECTIONS
? Stucco/Stone
APPROVALS
Planning Building U16 Engineering
sq. ft.
sq.ft.
Footprint sq. ft.
Census Code
MC/ES System
City Water
Booster Pump
PRV
Fire Sprinklered
Variance
/? .
? 31 Ext. Alt - Muiti
0 33 Eut. Alt - SF
O 36 MuRi
?
Permit Fee
Surcharge
Pian Review
License
MC/ES 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 Units
% SAC
MECHANICAL (RESIDENTIAL)
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5674
Please complete for. Single Family Dwellmgs
Townhomes and Condos when pemilts are required for each unit
:!? 30:0
Date _2 / 30 / _0'_-?_
Site Address Unit #
Property Owner ?_.?(x}?T i2o / /C( .tid Telephone # LZ/ )"Y.?,? - ?S o?c (?
Contractor
12481 Rhode Island Ave. So
.
Street Address
City
State Zip Telephone # q,SZ)
The Applicant is _ Owner Y Contractor _ Other.
Add-on, modification or alteration to existing dwelling unit $ 30.00
fumace replacement
air exchanger
? air conditioner
other
State Surcharge $ .50
T
t
l Su
?
o
a .
I hereby apply for a Residential Mechanical Pernut and acknowledge tUat the information is complete and accurate; that the work will
be in conformance with the ordinances and codes of the Ciry of Eagan and with the Mechanical Codes; that I understand this is not a
permit, but only an applicauon for a permit, and work is not to start without a permit; that the work will be in accordance with the
appro ed plan in the case of work which requues a review and approval of pla
RresY&1-)6t_/J ( TLfZ?Z ?/ zz_/lGpi?
ApplicanYs Printed Name Applicant's Signature
i,
c . r.
cEtTIFIcATE oF sURvEY M 3 2-19 5 6- 9 9
" for
D.R. HORTOPI
/
O?
?O
J?
I \?-J
Govern
DESCRIPTION
I hereby certify that this survey, plan, or Lot 7, Block 3,
report was prepared by me or under my direct GARDENWOOD PONDS SECOND
supervision and that I am a duly Registered Dakota County, Minnesota
Land Surveyor under the Laws of the State
of Mjbnesota. Plat bearings shown
Date
o Denotes iron monument
No. 8140 ? Existing? Proposed
BRANDT ENGINEERING &
1600 West 143rd Street,
Burnsville, MN 55306
(612) 435-1966
O? ?
? ?
9 ?a.SJ
cl,?
i?
I-}OUS? = Z, 103 SQ.FT
LDi = 12,19g SQ.Fr
To ? cu`tb to Gar slab C)-
Top block = 2)7k9
Lowest bsmt flr = _QID-.IL
SURVEYING
Suite 206
?." r-. n/1 r/? rl rl
CERIIFICATE OF SURVEY M 3 2-19 5 6- 9 9
' for
D.R. HORTON
O? ?
? /
0?
\0
?
?ry
v?
D^
u n ?i
/
?
32?
?t?
(9
i`
/
/ CO
? g0' p ,
23,S?Op, \
, ' y ^? S2 Si
yQB, ?.
A P ? a
?r s?a .• ?{?"?
e h ? Y
4r •J'?s? ?T? 9??p6 ry
? 91
d, ?A9
61
.. ? /
101
S
- ? ----
-- _.r-: - --.
Scale: 1" = 30'
?kUS? = 2, 1123 SQ.V-T.
LO i = 12,1q8 5'0_FT
14.
8j'14g7••w
?,?`
To cuh to Gar slab 3,C)
J Top block = 9l1$9
Lowest bsmt fir
874 Govern Circle
DESCRIPTION
I hereby certify that this survey, plan, or
report was prepared by me or under my direct Lot 7, Block 3,
supervision and that I am a duly Registered GARDENWOOD PONDS SECOND
Land Surveyor under the Laws of the State Dakota County, Minnesota
of?sota. Plat bearings shown
o Denotes iron monument
Date 9?I-9R 1994 Reg. No. 8140 ? Existing j Proposed
f>i.. ?, r1n an -+
BRANDT ENGINEERING &
1600 West 143rd Street,
Burnsville, MN 55306
(612) 435-1966
?j
1
?
.:?"ui Oc??JOOe
? \" ?
9t70
W 9?9,aJ
?qb C1v
?• . *
SURVEYING
Suite 206
M32-1956-99
• - -- ' CERTIFlCATE OF SURVEY
for
D.R. HORTON
-:?- lvg l \
CO
O ? 90.
23.S?
?J O0, \
?
/
0
0
J?
; ?1L`?"d " y .? s2 S\
o ??? o, qI, ? \ \
m?
ej0o,
9oY.a '
?. ? A. ?
00 ?
61 -? \
.3
c1.-? ,
_ ?
---^ 9? to?
i
,
,
%
M32-1956-99
C).?
?j
? 9?7031
W 9?4.aj
?^ ? i
3
Hovs? = 2, ?a3 sQ.V-r.
LDi = 12119RSP.V-T
?1
:, J
3Y?
? 4
'14'S7"yy
Scale: 1" = 30'
Ty cuth to Gar slab = _3,C) _
Top block = 917,9
Lowest bsmt flr = _91Dl
874 Govern Circle
DESCRIPTION
I hereby certify that this survey, plan, or
report was prepared by me or under my direct Lot 7, Biock 3,
supervision and that I am a duly Registered GARDENWOOD PONDS SECOND
Land Surveyor under the Laws of the State Dakota County, Minnesota
of MiDnesota. PI t b h
Date
a eanngs s own
o Denotes iron monument
eg. No. 8140 ? Existing j Proposed
1--
BRANDT ENGINEERING & SURVEYING
1600 West 143rd Street, Su ite 206
Burnsville, MN 55306
(612) 435-1966
? e -7 r-, 11 rl? rr-
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA117561
Date Issued:10/21/2013
Permit Category:ePermit
Site Address: 874 Govern Cir
Lot:7 Block: 3 Addition: Gardenwood Ponds 2nd
PID:10-28801-03-070
Use:
Description:
Sub Type:Reroof & Siding
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
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 -
Randy J Lachney
874 Govern Cir
Eagan MN 55123
(501) 908-9271
Companion Construction
3305 Harbor Lane North
Plymouth MN 55447
(763) 227-9685
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA117562
Date Issued:10/21/2013
Permit Category:ePermit
Site Address: 874 Govern Cir
Lot:7 Block: 3 Addition: Gardenwood Ponds 2nd
PID:10-28801-03-070
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, call for framing
inspection. Call for final inspection after installation.
Carbon monoxide detectors are required by law in ALL single family homes .
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 -
Randy J Lachney
874 Govern Cir
Eagan MN 55123
(501) 908-9271
Companion Construction
3305 Harbor Lane North
Plymouth MN 55447
(763) 227-9685
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA122732
Date Issued:05/19/2014
Permit Category:ePermit
Site Address: 874 Govern Cir
Lot:7 Block: 3 Addition: Gardenwood Ponds 2nd
PID:10-28801-03-070
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
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.
Randy Lachney
874 Govern Cir
Eagan, MN 55123
Fee Summary:PL - Permit Fee (WS &/or WH)$55.00 0801.4087
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 -
Randy J Lachney
874 Govern Cir
Eagan MN 55123
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA124274
Date Issued:06/26/2014
Permit Category:ePermit
Site Address: 874 Govern Cir
Lot:7 Block: 3 Addition: Gardenwood Ponds 2nd
PID:10-28801-03-070
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.
Phil Holmin
3432 Denmark Ave #228
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 -
Randy J Lachney
874 Govern Cir
Eagan MN 55123
(501) 908-1482
Holmin Heating & Cooling Llc
900 Park Knoll Drive
Eagan MN 55123
(651) 405-3853
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA174289
Date Issued:01/13/2022
Permit Category:ePermit
Site Address: 874 Govern Cir
Lot:7 Block: 3 Addition: Gardenwood Ponds 2nd
PID:10-28801-03-070
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
Census Code:434 - Residential Additions, Alterations
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: 1,500.00
Fee Summary:BL - Base Fee $1500 $62.50 0801.4085
Surcharge - Based on Valuation $1500 $0.75 9001.2195
$63.25 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 -
Bennett Nason
874 Govern Cir
Eagan MN 55123
(651) 252-1578
Window World Twin Cities
2106 11th Ave E
N St. Paul MN 55109
(651) 770-5570
Applicant/Permitee: Signature Issued By: Signature