4557 Kirkwood CirCASH RECEIPT
CITY OF EAGAN
L?'3 3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE 19
weC iReo
?
AMOUNT $ I
& DOLLARS
1 oo
Fl CASH [-] CHECK
FOR
FUNO CODE pMOUNT
Thank You '
H Y
U ?
White-PaVers Copy
Yellow-Posting Copy
Pink-File Copy
CITY OF EAGAN
3793 Pilaf Ksob Rood Eegan, MN 55142
PHON[: 43f-8100
'BUILDING PERMIT Receipt #
Te be wed fer Est. Value Dote 19
Site Address Erect
Q
Occuponcy
Lot Block Sec/Sub. Alter p Zoning
Portel # Repair ? Fire Zone
?
N Enlarye ? Type of Const.
W ame Move Srories
; Addreu Demolish ? Length
?
Ci phone ' 3
Grode
?
Depth Sq. Ft.
-
p Name Approvah Fees
??
?? /?dre? Assessment
~ Cf Phone Water 6 Sew.
? Police
?W Nome
FZ Fire
?, Addreu E?,
<'Z" Ci PFwne Plonner
Council
I hereby ocknowledge that I have read this applicotion and state that gldy. Off.
the intormation is torrect and agree to wmpiy with all appljcoble
Stote of Minnesota Statutes and City of Eagan Ordinunces. APC
Sipnoture of Permittee
A Building Pertnit is issued ro:
ull work shali be done in accordonce with all i
Buildinp Officiol
Stote of
Permit
Surcharqe
Plan check
SAC
Wuter Conn.
Woter Meter
Road Unit
Totcl
on the enprcss conditfon tha+
vlinnesofa Statutes and Clty of Eopan Ordinances.
i?
Permit No. Permit Holder Misc. Parmit No. Holder
Sees
Plumbinp ,2R' g{•u???i . 'j'
H.V.A.C. ? SE?Sv? (? 23-8
Wrll
Water
D'up.
Sawer
Eketrie "l?L7Q ? ,•?yl /-{? pfL
IrWaetion Date Inap. Other
FootinYs Q-$L A
Foundation
Freminp
Rouyh Plbg. .
Rouph HVAC
InwlMion 7
Final Plba . ?. • • •
Final HVAC .t1 p ' ?
. .
Final
Water Descri6e Location:
WeII
Sawar
Pr. DMP. '
Receipt MECHANICAL PERMIT Permit No. .?
CITY OP EAGAN .
Fee
Fill in numbered spaces S/C
Type or Prini /egibly Tot. '
1. Date 2. Installation Cost
?. }
3. JobAddress 'Lot Blk. . ? Tract
4. Owner r.
? - -
?
5. Contractor
6. Address
/ 3/0
7. City State Zip
8. Building Type: Residential [3-' Commercial ? Institutional ?
9. Work Description: New [l• Add ? Alter ? Repair ?
10. Describe `- ?- Fuel Type
,
1 11.
No,
- Equioment 8TU - M. Ea.
Forced Air No. Equipment CFM
Ai
H
dli
Mfg. r
an
ng:
_ Boilers
_
. ?? -
Mfg
.
- Mech. Exhaust
Unit Heater
Mfg, Other
_ Air Cond.
Mfg,
G Gas, Piping Outlets !
12. I hereby certify that the above information is true and correct, and 1 agree to
comply with all ordinances and codes governing this type of work.
Signed: for
Rough Ftnal
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
Receipt ' PLUMBING PERMIT Permit No.
CITY OF EAGAN
Fee -
Fill in numbered spaces S/C
Type or Print legibly
Tot.
1. Date 2. Installation Cost
3. Job Address Lot Blk. Tract ?
i
4. Owner
i
5. Contractor Phone ?
?
6. Address ?
I
7. City State Zip
8. Building Type: Residential ? Commercial ? institutional ? ?
9. Work Description: New 0 Add ? Alter ? Repair ?
10. Oescri be
11.
No. Fixtures
Water Closet No. Fixtures
Cesspool/Drainfield
_ Bath tubs Septic Tank
_ Lavatory Softner
Shower Well
_ Kitchen Sink
Urinal/Bidet Other
_ Laundry Tray
Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outleu
12. 1 hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed
Rough
Inspections: Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
for
F inal
Oate Insp.
?_j
INSPECTION RECORD
? CITY OF EAGAN PERMIT TYPE: 011.
+
3830 Pilot Knob Road `•! ?"' "' `? r
Permit Number.
Ea an, Minnesota 55122-1897
9 Date Issued:
(612) 681-4675
!
SITEADDRESS: APPLICANT:
? . ..,., ? ., ? . i .. { _ ? .? i. .
PERMIT,$qBTYPE: TYPE OF WORK:
?.
PermitHolder Date Telephone#
PLUMBING
HVAC
Inspection Date Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING i/??
S?GQ `
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
DOMESTIC
METER
IRRIGATION
METER
FLUSH
MAINS
CONDUCTIVITY
TEST
HYDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAI.
CITY OF EAGAN Remarks
Addition T ADDN. L t 4 131 k 3 parcel 10 17150 040 03
screet 4557 ircle State Eagan, MN 55122
Owner ?? w0 0
s-
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. 2097.72 A011438 9-16-82
STREET RESTOR.
GflADING
SAN SEW TRUNK Jt? 168.00
*SEWER LATERAL 2037.12
WATERMAIN
*WATER LATERAL
WATER AREA S16 IE)S. OO of
STORM SEW TRK J!'e 210.66
:rSTORM SEW LAT 1981
CURB & GUTTER
SIDEWALK
STREET IIGHT
ROAD UNIT 240.00 # 0647 6-21-82
WATER CONN, 420, OO it it
BUILDING PER, 7358
SAC
PARK
OF EAOAN
Pita Knob Road
MN 55122
Addreu:
No.:
WATER SERVICE PERMIT
PERMIT NO.:
DATE:
No, of Units:
y-31 c,M. F i /5
Connection Charge: 41Z'D• 01)
Actount Deposit:
Permit Fee:
Surcharge:
Misc. Charges: - 6?• ?? ?
Totol:
Date Paid:
eader No.:
agrae to eomplr wit6 Nha Ciry of Eagan
CITY OF EAGAN SEVNER SERVICE PERMIT
3795 P11of Knob Road PERMIT NO.:
Eagan, MN 53I22 DATE:
Zoning:
Owner: No. of Units:
Address:
Site Address:
Plumber.
1 00. o0
1 agree to eoinylp with Yho City oi Eagan Connection Chorge:
Ordinancos. Account Deposit:
Permit Fee:
Surcharge:
BY Misc. Charges:
Date of Insp.: Total:
Insp.: Dnte Pold:
Po Y&'rwu? U)a°o rLEE?-E_c? Cw- pnu? )
CITY OF EAGAN -?aclude 2 sets of plans,
1`- l 1 site plan w/elevations &
`0 `CA I BUILDING PE.RMIT APPLICATION 1 set of energy calculations.
To Be Used For ?e cvaluation ?Q'p D Date .? ?43
Site Address: `IS.f 7 /<,Y,bwv0j C,'rele OFFICE USE ONLY
Lot ? slock 3 sec./sub.CtilEs Ma_f` p iJ'"?e? ? ??Pan?Y
Parcel #: _ 16 (`7 ( 5C) 440 0--1 A1ter Zoning
Repair
Owner: _ f 1A-?? E. ?-?G?`f ? e ge
Address: ySS7 ?C; vKw ?o c/ Dezrolish
G ad
Fire Zorie
Type of Const.
# Stories
Front ft.
City/Zip Code: ?a•,o?.?- yY/?J I 2- 2. r e Depth f*
Phone #: el.5' Z' 3 ??h P.PPROUAIS FEES
Contractor: S
Address:
City/Zip Code:
Phone #:
Arch. /Eng. . S ?
Pddress:
Assessments Permit
Water/Sewer Surcharge ?
Police Plan Check
Fire SAC
Eng. Water Conn.
Planner Water.Meter
CounCil _
Road Unit
Bldg. Off.
APC
City/Zip Code:
Phone #:
TOTAL
CITY OF EAGAN
„. ? 9795 Pilot Knob Raad Eogan, MN 55122 N? 7358
PHONE: 45?-8100
BUILDING PFjRMIT Receipt # 310e,'17
Te ba wed fer sF nmr:/r_nR Est. Value $66.000 onra June 21 i9S2
$ite Address 47D/ !fl=KWOoa C1IC1@
Lor 4 BI«k 3 Sec/Sub. Chea Mar East lSt
Parcel # 10 17150 040 03
a Name Slilie Oonstxuction Co.
W
Z Address 644 Supez'fos Ct. e
t ir;...Eacran 55123 e?___ 454-1938
°C I Nome BGin@Y
ig
0l Addreu
F- ?:... ??---
Name _
Address
I hereby acknowledge that I hava read this opplication ond state that
the informotion is correct and ogree to comply with oll applicable
State of Minnesota Statutes gn
jk-f-ity of Eagan Ordinancgs..
Erect M Occupancy R-3
Alter ? Zoning R-1
Repair ? Fire Zone NA
Enlarge ? Type of Const. V
Move p # Stories
Demolish ? Length 48
Grade ? Depth 41 Sq. Ft.-
Approvols Foes
Assessment _
Woter 8 Sew
Police
Fire
Eng.
Planner ?
Council _
Bldg. Off. _
APC
Signoture of Permittee
A Buiiding Permit is issueA to: ilie (,bti8tri3Ct
oll work sholl be done in ccwrdance with oll app ble Stote
Building Officiol
Permit J31. V V
Surchorge 33.00
Plon check 165.50
SAC 525.00
Water Conn.420.00
Woter Meter 60.00
Rood Unit 240.00
Totol $1774. 50
on the express condition 1hm
ond City of Eagan Ordinonces.
?
?L?(L> s ? LCv??C? s.
( CITY OF EAGAN F? l-? ,I?-y ??Include Z sets of plans,
rS V7 ?g/ K'( 1 site plan w/elevations &
BUILDING PERMIT APPLICATION 1 set of energy calculations.
?',a.
Zb Be Used For Valuation ? Date -Ft:2-
Site Address ?h
??.?a? ? i t`kW 0 c?. ?? , ?_ -5,t OFFICE USE. ONLY
IAt ? Block ? Sec./Sub. C°??cn Erect ? Occupancy
Parcel # : 10 t `? ? sc,?) G qb ?? -:?,
Address: ep
City/Zip Code:
Phone #:
Contractor:
Address:
City/Zip Code:
Phone #:
Arch./Eng..
P,ddress :
City/Zip Cade:
Phone #:
Alter Zoning ZL)
Repair Fire Zone &JL?
Enlarge Type of Const. 4:0"
Nbve # Stories
Demolish Front ?j ft.
Grade Depth ft.
APPROVALS FEES
Assessments PernLit 73)
?aater/Sewer Surcharge 33
Police Plan Check ? ?i°
Fire SAC '?5-* S eg
E7ig. ater Conn. .?
Planner Water Meter 60
Council Road Unit
Bldg. Off, i
APC
,O
"AL __7 Tq -(-
??? ? , (o TSA-
r
*1'3; `a
6s',? ° g
???9yy/? REQUEST FaR ELECTRICAL INSPECTION „-;? EB-00001-03
T ?a??j ?/ ? p' See instructions for campleting lhis farm on bE?ck of yellow copy.
??'--
l
? i 1 l.l
?'i??: w Work Covered by Thrs Request 3e.) g(p I
NeW Add RBp. Type ot BUilAing ApplienCes WireA Equipment Wifed
Home Range Temporary Service
Duplex ater Heater Lightiny Fixtures
Apt. Buildiny Dryer Electnc Heatin
Commercial Bldg. Furnace Silo Unloader
Industrial Bldg. AIr Conditioner Bulk Milk Tank
Farm OthPr Sneci fv [hcr (5uecify)
ther ISpeci(y Othor Othcr
(.bmpuie lnsnection Fee Rvlnw
# Fee ServlceEntranceSize # Fee Peeders/Su6feeders 4 Fee Circuits
() to 100 Am ps 0 to 30 Am ps 5-70 0 to 30 Am s
s 101 to 200 Amps 31 to 100 Amps 31 to 100 Am s
Above 200 Am ps Above 7 00_Amps Above 100_Amps
Transiormers Remote Control Circ. Partial%Other Fee
Signs Speciallnspection
Remarks
TAL
RouBh-in D
te
` I .
ctor, herehy
tif
th
Final
,
flnte
Q cer
y
et the a6ov¢
ins ection has b¢¢n
made.
inis request voiU
18 months from
This requesj void ? I 2 L( ? lQ 1
18 mon!h5'trom "? ?"( r2 !J?
T -'79970
Request Date Fire No. Rouyh-in Inspection ,??
ftequired? ?° ill Notify, Inspec-
?Ready Now
?s ?No y
' N? w??en Ready
X??Licensed Electncal.COn[rac[or .. I h¢reby request inspection oi a6ove
O'
? Owner electricai work instalied at:
Slree?t ,JAddress, Box or oute o.
? ///,?/, ? C
" ! ? . ut/ C?
ection o. Township Name or No. Range No. Com ((//
?
Occu ant INT) d! ? Phon No.
Po er ppl'er AAdress A
?
Electni I Cont ctor (Cam Name) Cor ctor's license No.
3` S?
MailingAddrecs IConhactor Owner aking Inslailati n1
?-
•-?.?J
Authorized SiBn re ICon r clor/Own kin 16 tallation) Phane Number .-?
3
i
MINNESOTq S7qTE BO OF ELECTRICITY /7HIS INSPECTION REQU.EST WILL NOT Griggs•Midway Bldg. - Room N-791 . gE ACCEPTED BV THE STqTE BOARD
7821 University Ave., St: Paul, MN 56104 . -UNLESS PNOPEfl INSPECTION FEE IS .
ph,,,,e 99191 297_9111 ENCLOSED.
(Ekt.r#tf irtt#r of Orruvan.rg
Citp of Cagan Drpttrtmrn# rrf Builbing 3nsprrfinn
TbiJ Cesti ficate ittuad purraant to tht ttquirements of Section 306 o f tbr Unifarm BuiJding
Code urti f ping tAat at tht time o f ittnana tbit rtructure war »r com plianct with the variout
ordinanas of tlx City regulating bnilding connnution or use. For the f ollowing:
SF DWG/GAR &as.peom;t No. 735£3
u,e ckuit"nm
°OcmPw.yryP, R3 rypcomuuctim V enezmft. t7A Zo,JnBniwria Ri
a,M,fBA"sBlilie Const. Co. Add? 644 Superior Ct., Fagan
5,jd„?A4&, 4557 Kirkwood Cir. Lw,ry Lot 4,Block 3,Ches Mar Ea;
1? ? l Bylst
: w..:u?,,.nrnd? L._ wn: August 2?? ?.982
roai 1. w ?G ?<e
u.s.n.
FERMIT
Cla Y oOF?EAGAN
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
P.I.N.s 10-17150-040-03
PERMITTYPE: BUTLDING
Permit Number: 0 3 3 3 9 6
Date Issued: 09/23 /9$
4557 KSf2KWO0Cl CIR
LOT: R 6LQCK: 3
CHES MAR EAST 15T
DESCRIPTION:
REROOF
u4'1"$fi'Mmg•?P e r m i t 7 y p e
(Jird?:ng 'W°o.rk Type
ensur. CpcEe`"•°m???.
aq,
44, s
= e5?'
i.•,.:a3?a,-
? F .'a
s
s 4oA-Y\
REPAIR
434 ALT. RE5IUENTIflL
s2S d?4'33?:4i s' n?p!
v d rM
t! h
¢i'?F
? ? 1m? rt
??t r
" ?e t
"naE ?iaaqV 'jfKaiv 9s.ae ?"???€
REMARKS:
FEE SUMMARY:
PQfkNLTt?FTIQv?' - Appl.tcant - ST. L'!C. OWNER:
15465939 2m127056 LEMKE AftT
5261 EDTNA IIVD'L BLVD. 4557 KIRKWQOD CIR
ERTNA MN 55439 EAGAN MN
(612) 546-5939 (651)376-3364
?
r ?
1998 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3$30 PII.OT KNOB RD - 55122
681-4675
New Construction Reauirements
? 3 registered site surveys
? 2 wpies of plans (inGude beam 8 window s¢es; poured fnd. design; etc.)
? 1 energy calcWations
? 3 copies of Vee preservation plan if lot platted after 711193
required: _ Yes _ No
DATE
DESCRIPTION OF WORK:
STREET ADDRESS:
,?ec-'r J 0 4-
RemodeURepair Requirements
? 2 wpies of plan
? 2 site surveys (exteriar additions 8 decks)
? 1 energy calculations for heated additions
CONSTRUCTION COST; ?00
'- rr-e) t ?`? f Ar?,
LOT: ? BLOCK: ? 3 SUBD./P.I.D. #:
Name: LerM i?? Pf- ?
PROPERTY Luc Firsc
OWNER 46? L"l/?-
crrnnr ?rili«occ• ? L !(? ? t JN717
49
CONTRACTOR
Company: A ?a 1 #: ??? c- ? 3 I
,
City LQ/1 State: Zip:
Street
City C<- ,7tlv? _ State:
Phone #:
( t ?
?531r C?127Q.5 b
? icense #
Zip: 27
ARCHITECT/
ENGINEER Company:
Phone #:
Name: Registration #:
Street
City State:
Sewer & water licensed plumber (new construction only):
and lot change is requested once permit is issued.
Zip:
Penalty applies when address chanc
y with all applicat
I hereby acknowledge that I have read this application and state that the information is corr t a77
State of Minnesota Statutes and City of Eagan Ordinances. ?
Signature of Appiicant: ?
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
Tree Preservakion Plan Received _ Yes _ No _ Not Required
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex
? 02 SF Dwelling ? 07 4-plex
? 03 SF Addition ? 08 8-plex
? 04 SF Porch ? 09 12-plex
? 05 SF Misc. ? 10 = plex
WORK TYPE
? 31 New 0 33 Alterations
? 32 Addition ? 34 Repair
GENERAL INFORMATION
Const. (Actual) _
(Allowable)
UBC Occupancy
Zoning
# of Sfories
Length
Depth
? 11 Apt./Lodging ?
? 12 Multi Repair/Rem. ?
? 13 Garage/Accessory ?
? 14 Fireplace ?
0 15 Deck
? 36 Move
? 37 Demolition
Basement sq. ft.
Main level sq. ft.
sq. ft.
sq, ft.
sq, ft.
sq, ft.
Footprint sq. ft.
APPROVALS
Planning
Building
16 Basement Finish
17 Swim Pool
20 Public Facility
21 Miscellaneous
MC/WS System
City Water
Fire Sprinklered
PRV
Booster Pump
Census Code.
SAC Code
Census Bldg
Census Unit
Engineering Variance
Permit Fee
Surcharge
Plan Review
License
MCNVS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
SNV Permit
S!W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
Valuation: $
% SAC
SAC Units
?-
?
f . .•??_.?-..?--»? _ ? .. ` ?7 ?? rrd4 ? r r i ? '1 f y u . Y t? ?? i? I i?X?, '?y??' '?.. R ? . .. . ? - - ?
-t r?7-
N /??-?1
PLOI" PLAN Scale -- ; ;nr.ii -E,?
/ , .
/AQ '
o ? -••?f ?" - r.-??? _'- r?'a.l .. - I" ? ". i ? r? '.? ?- .r _r-"
n\ ? ?. .. t ..I 1
,
?-
r tt ;ya.
p /a.? : -n'1 =, r- + , +. ?,? •_?: ?r„ ?,? ;..' _ , _ .y
?
?? ' + (
'
? a
t I._.Irt
±fiil
".?'_'_ .j ..
?j
, r
.??? ?it?
";Ei . ?? ;?
? .
??
?-l. ? ,-
•" + ? J
ti ?. ? t-???i
ti?
, i T
, , . r i-- - -. "
y 1 1 1
.J f
HY ,?? _Y . 1y1. 1?•1 {' J Y Fl •? ?.?. I. . J. f ? ? ? j 11 4 ! J ___ ,?._L_.. _
I
• • ? .? ...+n . l. ? _' '. .. ?_ _
- 1-?
?4 1 ?.-1
1
. ??; } ? ?
f ?
' ' µ
?}- •
-L . .
:? ? ?t +`!r ,?»,?+ ::!f . ?` ? +? ?` '?'? ?:,i. ,;??? i . ? ? i II 1?? ?'?' ??i?: Tr. '` -. ?
.'? i .t( ? j { ? ?• ? .I . ?? i .? ? ' i ' ' '
a
?.t..}? ?
i?i
.
,r.i; :-
?? ??.• ,rr -?FI i !'r- I ??..?.i. -i'' ? ~?? I: ''.. . ? "' ._l._
-777 7
;1 ?? • I *
7 'j:?' TZt:? i
r
- ? ` - 1-;:'.; i•' , j } ? ' ? . 'I. '_II i ? - ? ;
..
? ?
ANI
--
. 1 ? , .. ? .
; : .
t{
.1
L ?
? . . .. ' ?.r - .1 1 1
:F
Muss show Iocation of streets, lot and proposed Uuiidings; give lot dimensions. (Lot cornerq.
are to or, staked before appraisal is requested.)
. •
c
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA173798
Date Issued:12/03/2021
Permit Category:ePermit
Site Address: 4557 Kirkwood Cir
Lot:4 Block: 3 Addition: Ches Mar East 1st
PID:10-17150-03-040
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 -
Arthur G Lemke
4557 Kirkwood Cir
Saint Paul MN 55123--190
(651) 343-2338
North State Mechanical
1444 14th Street W
Hastings MN 55033
(612) 207-0345
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA175639
Date Issued:04/11/2022
Permit Category:ePermit
Site Address: 4557 Kirkwood Cir
Lot:4 Block: 3 Addition: Ches Mar East 1st
PID:10-17150-03-040
Use:
Description:
Sub Type:Water Heater
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 -
Arthur G Lemke
4557 Kirkwood Cir
Saint Paul MN 55123--190
Tony's Appliance Inc.
2090 County Road 42 West
Burnsville MN 55337
(952) 435-2442
Applicant/Permitee: Signature Issued By: Signature