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613 Greenleaf Dr SSEWER & WATER PERMIT CITY OF EAGAN 3830 Pilot IFnob Rd. Eagan, MN?55122-1897 SITE ADDRESS LOT BLOCK?SEC/SUB APPLICANT: ADDRESS: {`-' /3 --Sc. • ? ? ?' c ?-• ! C 4 ?---? CITY, STATE ZIP PHONE: -7 c/ v L. '7 7 2-- ?S PLUMBER: ADDRESS: -c/'S- Ci?"???-' ?c i 1 AGREE TO COMPLY WITH CITY OF CITY, STATE ?- -- '-?t-?-^ h't ZIp EAGAN ORDINqNCES: PHONE: L1'? Z - / ? ?_ `? ? .'•l . . ?% i? G??'• - -- r OWNER: r i" ..?-•`. K ? ?. L,? ?. ? ?_, r.? n ? ADDRESS: c-i:1 -'Sc C-= t L- SIGNATURE WHEN METER ISSUED CITY, STATE zip,673 ?Q-- PHONE z-- PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. FOR STORM SEWER PERMITS, CONTACT ENGINEERING DEPT. APPLICANT AND PLUMBER WILL BE NOTIFIED WHEN PERMIT IS PROCESSED. OFFICE USE ONLY METER # CHIP # - METER SIZE ISSUE DATE PERMITDATE 5124/89 WATER PERMIT # 1Q452 B.P. RECEIPT # ? ? lb4 B.P. RECEIPT DATE 5% 2 3/ 69 _ PRV _ BOOSTER PUMP PERMIT REQUESTED = SEWER ? WATER - TAPS - COMM/IND - RESIDENTIAL NEW ? EXISTING SEWER & WATER PERMIT OFFICE USE aNLY CITY OF-EAGAN METER #6? :!?? PERMIT DATE 5/ 24 ? 89 3830 Pilot Knob Rd. Eagan, MN 55122-1897 CHIP #4d05 00 7 WATER PERMIT #?u45? METER SIZE B.P. RECEIPT #C 2104 ISSUE DATE 0B.P. RECEIPT DATE '/ 2 3/ 89 /?. PRV - BOOSTER PUMP SITE ADDRESS ? /3 ??' • ?=-, ' ? ? ^ ??' ? ?? LOT BLOCK '' SECISUB '-_I a? Q?--? APPLICANT: ADDRESS: fi° /-4 -?,v. C?,-?'rt-..If c:.., •?.., CITY, STATE ^' n?' ? • ZIP •-h, -` '? ? PHONE: 406!; 7 t5_'?'?S3 PLUMBER: e x-*"f t ADDRESS: ?Q<ci <- CITY, STATE 4t?s_? AA PHONE:I/I OWNER: jr;7-CZ.-^ K? L J??1 ? S C ? ADDRESS: 61 3 6t, G rc- e n I eC. t ? C{TY, STATE rI•i? M Li Z1P,?-; r 2? PHONE: Z=4-?? - JZ S''t Z PERMIT REOUESTED ? ,-' SEWER = WATER - TAPS COMM/IND .? RESIDENTIAL - NEW ,._ EXISTING I AGREE TO COMPLY WITH CITY OF EAGAM ORDIN!}NCES: r }?? j?_1J?-• ?...? 7G"ifg) *NR I S S U E D PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. FOR S70RM SEWER PERMRS, CONTACT ENGINEERING DEPT. APPLICANT AND PLUMBER WILL BE NOTIFIED WHEN PERMIT IS PROCESSED. CITY OF EAGAN Remarks Addition South (laka Lot ?S Blk 3 Parcel 10 71200 060 03 owner i=? U'? -?.• _.? ?? ? Street 613 So Groenleaf Dr. State Ea,qan,MN 55123 Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. STREET RESTOR, GRADING SAN 5EW TRUfVK 1984 370.00 7 1 SEWER LATERAL WATERMAIN WATER LATERAL WATER AREA STORM SEW TRK ? 1984 617.00 41.13 1 S70RM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. 9UILDING PER. sac 9142 10-5-73 PARK Fw PRICE Site Address W 1 J Lot ._..1Q- Block .. Name ? Addre c City J BING PERMIT For Office Use Only f OF EAGAN PERMiT # ROAD, EAGAN, MN 55122 RECEIPT# C- ?109 NE 4548100 DATE: ` fc, BLDG. TYP WORK DESC IPTION Sub Res. New Mult. Add-0n Comm. Repair , Other FEES COMM./IND. FEE -196 OF CONTRACT FEE APT. BLDGS. - COMM. RATE APPLIES TOWNHOUSE & CONDO - RES. RATE APLLIES MINIMUM - RESIDENTIAL FEE $12.00 MINIMUM,- COMM.IND./FEE $20.00 STATE SURCHARGE PER PERMIT .50 (ADD $_50 S/C PER EACH $1,000 OF PERMIT FEE) RES. PLBG. ONLY - COMPLETE THE FOLLOWING: NO. FIXTURES TOTAL Water Closet - $3.00 $ Bath Tubs - $3.00 Lavatory - $3,00 Shower - $3.00 Ktchen Sink - $3.00 UrinaUBidet - $3.00 Laundry Tray - $3.00 Floor Drains - $1.50 Water Heater - $1.50 Whirlpool - $3.00 Gas Piping OuUets - $1.50 (MINIMUM -1 PER PERMtT) Softener - $5.00 weu - $10.00 Private Disp. - $10.00 Rough Openings - $1.50 PERMIT FEE: 1 Z `v STATES S/C: S u GRAND TOTAL: ? ? ' Sa REQUEST FOR ELECTRICAL INSPECTION es-ooom-oa ' Sea ins[ructions for comoleting this form on back of yellow copy. X" gelow Work Covered by This Request 3L//-1 ? Fdd Rep. Typqof Builtling Appliances Wired Equipment Wired ? Home Range Temporary Scrvice Duplex Water Heater Lightiny Fixtures Apt Building Dryer Electric Neatin Commerciai Bldg. Furnace Silo Unloader Industrial 81dg. Air Conditioner Bulk Milk Tenk FHffil Dther Peci y Iher (SuCr,ify) t 9! yCCifY t L'! 0 Iht!, ComUUte lnspection fee Below N Fee ServiceEntrenceSize # Fae Fexdera/5ubteaders N Fee Circuits 0 to 200 Am s 0 to 30 Am s 0 to 30 Am s Above 200 qm?s 31 to 100 Amps 31 to 100 Am s Swimmin Pool Above 100_Am s Above 700_/>m s Transiormers Irrigation Booms Partial.'Other e Signs Speciai Inspection S 7 Remarks S OTAL EE/ ? ' r ? ?V Rough-in Date ' ?,the al ? Inspector, he,eby er?ify thet the above Final //? ? (J ? ctian has been e. Thls ropuest voltl 18 montln trom /{,e?f?? ?S lLr? -- - k months (rom o;d (c 3 </o y l -75 f C" - Re9uired? ---•• 'QReadY Now Q Wili Nmifv. Insuec'I ?yes (]No tor When Ready ? Licensed ElecVical. Convac[or 1 hareby request inspectian o( abova ? Owner electncel work instelled et Svee[ AtlAres Box or Route No. City E ectmn o. Township Name or No? No. Co? ' Occuaant/ o?isC.. i CM?Jin ??. Ph?o?--7R?2-- RAW-.1 Supui-er a Address Electrical Contrac[or (Companv Name) Contrector's License No. MaflinB Address (COMractor or Owner Makinp Instailation) Av i r¢ ? or wner Maki 0 Install2lion) Phone Number MINNESOTA\$,EA4 BOARD OF ELECTRICITV THIS INSPECTION REUUEST WILL NOT Griggs•Midwey Blag. - floom N-187 BE ACCEPTED BY THE STATE BOA0.D 1821 University Ave.. St. Paul, MN 56106 UNLESS PROPEH INSPECTION FEE IS Phone 16121 297-2111 ENCLOSED. 1?-- 3-/ VILLAGE OF' EkGAN 3795 Pilot Knob ttoad Eagan, Minnesota 55122 PEftiv1IT N0. 175 The Village of Eagan hereby grants to Mrco=an ggcve, s Zmp. Co, af Rosemount, m 550$8 a wELL Permi.t for: (Owner) Frank Pabia 5° ' at 613 Greenleaf Drive ? pursuant to application dated 12/11/73 Fee Paid: $10.00 dated this 13th day of Dec. 19 73 . , .50 s/a Building Inspector Niechanic al P ermits : Bid Total: VILLAGE QF' E11GA1V 3795 Pilot Knob ttoad Eagan, IvLisuzesota 55122 PffMIT N0._ al7 The Village of Eagan hereby grants to ???U-1,4a_ 1 . , of 3901 Sra Ualieqr Uixa?nr±sro - n.p- In7 a ;DLWW=G Permit for; (Owner) aa?,p at 6l3 So Gtroe^?eef itx. r Pursuant to application dated 12424471 Fee Paid: $Za 00 dated this2Ath dap of Ti„n,,,,y,e,. .SO s/c Building Inspector Niechanical Permits: Bid Total: 6-3 J. d,4k,? VILLAUE QF' rAGAN 3795 Pilot Knob ttoad Eagan, Minnesota 55122 PERMIP N0. 443 The Village o£ Eagan hereby grants to grank J. Fabin af 3401 So. Valley Viev Drine Apt. 107 a HpATING Permit fors (Owner) same at 8613 So. Greenleaf Dzive , pursuant to application dated 12/24/73 Fee Paid: $20.00 dated.this 26th day of Deapmber , 19 73 , .50 s/c Building Inspector Niechanical Permits: Bid Total: EAGAN TOWNSHIP BUILDING PERMIT own.= ------....................................... Address (preseni) -'- ? - -.._....__... ...... ......... ..........--------- .. . . . q .C?/a 7 Builder .........-?.:`-'-----'-- Addresn .... .."?.....`"..'? ---__....._...-'--"-•--° .............--'----..._..... 1__?J ? N° 3151 Eagan Towaship Town Hall Date °:..... - .. 7-3 ° - ..-• -...._'---...... SSOriea To Be Used -For Fron1 Depfh Heigh! Esl. Cos! ermi! Fee Remaska av 9es 99- , N ` LOCATION qO•So Streef. Road or othex Deacripifon of Locafion I Lo! Block Addifion or Tsaet fo /3 4 . od2-c , I G 3 .Ac , This pesmit does not eulhorize the use of stseels, roadc, alleps or sidewallcs aor doea It give the owner or hfs agant the zi9bt fo creaie anp siluafion which is a nuiaance ox which presenLa a haserd !o the heal2h, saEeip, eonvenSenee and ganeral wel4are to anpona in the eommunifp. THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WORR IS IN PROS. TLis is 2o cezlifp, lhaf....?..:...?.?[C............................... .hespermission !o erec! a. ....-°°---?'?`.:°.:.??. --- ------------- .._upoa the above dascri6ed premise subjec2 !o the pravisioas of the Suilding Ordinanee for Ea aa Township adopted April 11, 1955 ............ '-...............--"......""-(L-Y`..---_"'-------.-•-?-------------- Per ............................... .................... ?-?r?v??................._................ Chairman of Tnwn Board Buildiq,g Inspector ? A?i±jonSouh Aaka - Lot ? alk 3 Parcel ZO 71200 060 O! ggqan.FIId 55123 Owner I?2? ?_. L?.. ' i ?? L J Street 613 .c-?-:teetilfie3f i]r. State_ Improvement Date Amount Annual Vears Payment Receipt Date STFEETSURF. STREET RESTOR. GFADING SAN SEW TRUNKi SEWER LATERAL WATERMAIN WATER LATERAL WATER AREA STORM SEW TRK i 1$ 617.00 41.13 1 STORM SEW LAT CURB & GUTTER SIDEWALK - STREET LIGHT WATER CONN. BUILDING PER. SnC 9142 10-5-73 PARK ?? . DATE: 5/24/89 RE-613 SOUTH CR.ENLFAF DRIVE, L6, H3, SOUTH OAKS XX Your Sewer & Water Permit for the above property has been completed. It will be held at the Public Works Garage (3507 Coachman Road) until the meter is picked up. BE SURE TO CALL PUBLIC WORKS (454-5220) FOR YOUR PERMANENT WATER TURN ON. Your Sewer & Water Permit for the above property cannot be completed for the following reasons: Your Sewer & Water Permit for the above property has been completed, but the meter cannot be issued or cecupancy allowed untll further notice. -- COMMERCIAL PROJECTS ONLY: Please pay for meter at City Hall. Meter size must be confirmed by Bill Adams or Dirk House (Plumbing Inspectors - 454-8100) before issuance. WARNING: BEFORE DIGGING, CALL LOCAL IITILITIES - TELEPHONE, ELECTRIC, GAS, ETC. , ' - REQUIRED BY LAW. ?CONT4! bOMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY. ., Secretary-yBuilding Inspections Dept. 6-3--/ S_ ea le-s OILLAGE QF r;AGAN 3795 Pilot Snob ttoad Eagan, Minnesota $5122 PEBivlIT N0. 170 Tha Village of Eagan hereby grants to Weierke Trenohiug & Excavating of 660 C11fE RoaB, Eagan , a SePLfc & Ceespool Permit £or: (pwner) Frank Eabin at 613 So. Greenleaf Dr. , pursuant to application dated 10/30/73 Fee Paid: $10.00 dated this30th .50ac - day of October , 79 73 Building Inspector Niechanical Permits: Bid Total: CITY OF EAGAN 5$WER & WATSR CONNECTIOLQ CHARGES - 1989 $SIgTtNG PROPkR't2$9 &EWBR CONNECTION C$ARGES WATSR CONNSCTION CHARGES SAC 7 ?3 d .00 WATER CONNECTION $ Previously Pd. 580.00 - . Previously P \ Receipt # )/q Z Receipt # ACCOUNT DEPOSIT 15.00 WATER METER 90.00 SEWER DEPO5IT 10.50 TREATMENT SURCHARGE 228.00 TOTAL e $-ZOA-.-50- ACCOUNT DEPOSIT 15.00 WATER PERMIT 10.50 PLUMBING PERMIT 12.50 TpTA1,; $ 936.00 TOTAL FOR SEWtR 6 WATER HOOK-UPi OFPICE US8 ONLY ? P1t0PER'PY OWNER: ADDR8S5! L' L! ? b t•3 ADD 3 ?/X-' ? L•?c??°-? WAIVER OF HEARING OF SPECIAL ASSIGNMENT City Project No. 536 I/We hereby request and authorize the City of Eagan, MN (Dakota Co.) to assess the following described property owned by me/us: _ . .._.__ ..,.,x«:.... d for the benefit zeceived from the following improvements, constructe under City Project No. 536. Said assessments have been preliminarily computed as follows: QUANTITY RATE ATtOUNT PRO ECT ITEM Sanitary Sewer 1 ea/lot 3,943.00 943.00 $3? 536 Lateral Water main Trunk 1 ea/lot 655.00 655.00 536 536 Area ateral ain I i ea/lot 3,252.00 3,Z52.00 00 g29 536 . Water m Services 1 ea/lot 929 00 934 00 , 934.00 536 Storm Sewer 1 ea/lot . 7 361.00 7,361.00 536 1 ea/lot , Street TOTAL R_17„ 074•U0 to be spread over 15 years at an annual interest rate of 9% against any remaining unpaid 6alance. their heirs, executors, administrators, e undersigned, for themselves , Th successors and assigns, hereby waive notice of any 8erlat d to r.hese and waive objections to any technical defects in any proceedings re eal from these assessments, and further waive the right to object to or app assessments made pursuant to thisragree? ? Dated: Frank J. Fabin \\J `^J" ' U I C)'A-A Louise J. Fabin STATE OF ? L '-\ COUNTY OF ??- On Jo ary Jruoi?zu?r a d who execut d the executed the same as )SS before me a this L.? f day of aPPeared lly and for said County, persona _ described in to me personally known to be the person oing instrument and acknowle ed that ?- ..' ?-?fxee act and dee?.? ? A. HARRIH?T?'N ? RMRGAR ,.,F??rn ? rt ? ? pIRE? 2 ?v?„wyvvr rr.N'r w APPROVED ks ?ire Eaganili Worctor , ,,.• TRAN:-r-`L' T `(?N 7a! Wk't3 Sf CI A4._ F i .' E.SMENTS ,., __?}"+t-`?: . i.. . . ,6?1?_. ,...? - '..;c :-„_, 1. ,- q'???._.ii?? r.? I t..l'. .. _. .-..:-?, ?_.. .._. .::cr ?p.,.l:l"I ?nl... nu: ?. i,i r:?r y Pr:OPE R;v I.D. Tt-r:A.; r.7f.rF. r5/1>/?• ?s, -- -..._ ?,?aF-? . ?_,T.: . . ,,;.?_?__ t ? ? ,-??, ? --.. ?. ? .. ._'__J S. ".._'_..., . _ . "'_i1 ;'_ - ;.., ",.__C:... 9.. . 1\ i ? i:7__'.r1.:. ,.. ili)-..f}% _. u? i-_iJ' `: .. _ ___ .. S.fia.# . . . . caS(',fi-iSMtN-t' . .... L:r,,;R, +r Y[ _ . . AlE ..._., _..... i.7T-;1_ _ . __.. . tiNN.F'RIi.l. __ A.,OP'f- , `_,LiMMi.-I',{r 10081 S_n ,.-.. .,.. . °:. ....?Iz. t:1.]i ... .:. :.J ?.,. 1::?,Jl.:°( . . 617.00 4.L.1?" 370.22 .,c , 7I.)i78' .. ,- .?.--rr-?? . r :: . ,_. . .. '-!_" , ?;:s :. ..?! ?:?.,:_ll) 370.00 .., .._^{' e?1:? .__...._:)O ii'iF'.`=i_c rt.iLlTl-I !.ii'lf-,S i..?TI'.. (L .i? . i:)?- :.S i:, ? ,?.??i;% _ L7074.00 17074.00 Iir r_ . _'•1.7?. ..P„L. ) y,. - ? ?iJhif'Ii3Fl''Y 01= ' . , "_ 'r.•:: T1:'vc_ q;.:,_,r,?.it::i 65.81 592.22 .?...K?pg.j;. ,....,-r..?.?.. ? , ?r?1?i T:'=.H;?, ._ ...._._?. ?.,??.? ?lji i _... ? :..? ? ?...:,?.,,t..:._ .?..}c?s..?.?y.?. ..j'._I?•??`' %IP=' I`';_Yl'I'P•ri j..,f..?'=E.:X; 17074`00 MASTER CARD LOCATION OWNER Y -ic STRUCTURE LAND USED ASD 4 AX I L II..P ' Permit I I No. Issued Issoed To Con}ractor Owner BUILDING 73' ,?. PLUMBING CESSPOOL - SEPTIC TANK WEIL SI..Q.? I ?J ?t2'2 GD?I Ry- ELECTRICAL HEATING 417 GAS INSTALLING SANITARY SEWER OTHER I OTHER i I Items ApprovetJ (Inifial) Date Remarks Distance From Well FOOTING SEPTIC FOUNDATION ' IA-1-23 CESSPOOL FRAMING FINAL ELECTRICAL ?,y TILE FIELD FT. HEATING y'-73 DEPTH OF WELL GAS WSTALLATION SEPTIC TANK CESSPOOL DRAINFIELD ? ? PIUMBING WELL SANITARY SEWER . -- ? -- ? Violations Noted on Back COMMENTS: ss Section WELI, RECORD VILLAGE OF EJkCAN L- 3 Lot B1 l9i(o.3 / 747'?? State Licence IJo. Permit No. Date fH Drilling Cocn.par:y Siza of TrTell_ 14/ Inchea ? Water Level /ZZ/ Feet Weil D2pth /C D Feet ? Draw Down Feet at /.s` _?GPM I Casing Depth Feet ` Capacity Gallons P?r/1IIi. r,f Started I Ehded I of ?5a J74 0 %li lD r t?f?f - -- % &0 F3i' ?i• ?lx'I 74{ Jw?`d f"/ ?:'t-/*- ? "'?ithK vCWrl /o713- IcJr`0 -;!S- Y"-e G'-'/ sCL/7 d !?'7 n /I?Pf.? A:? Te C_'.'- .. 1D 5fu z- ??i'S?'sfa?'a/t':? :Sf??/ -s c i- c°ei. . E7cterior Space Around Casing Sealed With: ElCement Grout W Puddled Cizy 13Other Disinfer,tant Used Hours Left in Well -- Dril`ler's SltCnwt,:r° HEEP[JRN THIS R: CORD AP'TER COMPLETION PERMIT City of Eagan Permit Type:Building Permit Number:EA119773 Date Issued:12/18/2013 Permit Category:ePermit Site Address: 613 Greenleaf Dr S Lot:6 Block: 3 Addition: South Oaks PID:10-71200-03-060 Use: Description: Sub Type:Siding & Windows/Doors Work Type:Replace Description: Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please print pictures of house wrap and leave on site for final inspection. 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 - Frank J Fabin 613 Greenleaf Dr S Eagan MN 55123 Renovations Unlimited Inc. 20509 Jewell St NE Wyoming MN 55092 (763) 227-0983 Applicant/Permitee: Signature Issued By: Signature WINDOlSODOORS Andersen. • May e,2014 C me h~ to Amk rsen: MAY 0 7 2014 Dear Renovations Unlimited and Jeff Wheeler {City of Eagan Inspections}: 77 3 In regards to the window replacement that took place at 613 S. Greenleaf Drive - Eagan, I believe standard size Andersen 400 Series Casement windows were used to replace standard size Andersen 400 Series Casement windows. The two model numbers used in the bedrooms are. C23 & 0235, We do not offer egress hardware for these sizes and will not sell parts to retroactively do this in the field, as confirmed by our order Center can April 29 h. I can assure you the current replacement units HAVE the widest clear opening Andersen allows for the C23 and 0235 units installed In the bedrooms. Please accept this letter as confirmation of suitability per city of Eagan's current building code, as relayed by Jeff Wheeler (City of Eagan Inspections). Thank You, Christopher M. Langin Andersen Windows i - - - PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA173265 Date Issued:11/05/2021 Permit Category:ePermit Site Address: 613 Greenleaf Dr S Lot:6 Block: 3 Addition: South Oaks PID:10-71200-03-060 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace 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 - Keith R Nelson 613 Greenleaf Dr S Eagan MN 55123 (608) 438-5887 Controlled Air 21210 Eaton Ave Farmington MN 55024 (651) 460-6022 X253 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA174615 Date Issued:02/08/2022 Permit Category:ePermit Site Address: 613 Greenleaf Dr S Lot:6 Block: 3 Addition: South Oaks PID:10-71200-03-060 Use: Description: Sub Type:Fireplace Work Type:Gas Insert Description: Census Code:434 - Residential Additions, Alterations Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Improvements to the home may require smoke detectors in all bedrooms. Chimney / flue must be inspected prior to concealing. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Valuation: 3,000.00 Fee Summary:BL - Base Fee $3K $88.50 0801.4085 Surcharge - Based on Valuation $3K $1.50 9001.2195 $90.00 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 - Keith R Nelson 613 Greenleaf Dr S Eagan MN 55123 Fireside Hearth & Home 2700 Fairview Ave N Roseville MN 55113 (651) 633-2561 Applicant/Permitee: Signature Issued By: Signature