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2142 Garnet DrCity of Eagan 3830 Pilot Knob Rd Eagan, MN 55122 (651) 675 -5675 www.ci.eagan.mn.us Site Address: 2142 Garnet Dr Lot: 29 Block: 2 Addition: Cedar Grove 1st PID:10- 16700 - 290 -02 Use: Description: Sub Type: e- Reroof & Siding Work Type: Reroof & Siding Description: Census Code: 434 - Occupancy: Zoning: Square Feet: 0 Comments: Fee Summary: Valuation: 6,000.00 Contractor: Minnesota Exteriors 8600 Jefferson Hwy Osseo MN 55369 (763) 391 -5514 Reroof: If there is no ice protection inspection prior to final, you must meet inspector with ladder and flat bar. Siding: When installing ventilated soffit material, remove existing material (ie: debris that could block vents) and take steps to ensure maximum ventilation to attic. Call for final inspection after installation. Christine Casaw BL - Base Fee $6K Surcharge - Based on Valuation $6K Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply of Minnesota Statutes and City of Eagan Ordinances. h all applicable State Applicant/Permitee: Signature PERMIT City of Eaan - Applicant - Construction Type: $132.75 $3.00 $135.75 Owner: Robert M Klatt 2142 Garnet Dr Eagan MN 55122 Permit Type: Permit Number: Date Issued: Permit Category: 0801 9001 Issued By: Signature Building EA084004 07/03/2008 ePermit CITY OF EAGAN Remarks * Cedar Grove Acquisition Addition CEDAR GMVE #1 Lot 29 eik 2 Parcel 10 16700 290 02 Owner , Street 2142 Gd2?let DL'iVB State Eag? , MN 55122 Improvement Date Amount Annual Years Payment Receipt Date STREETSURF. ? 1985 1266.9 84.46 15 STREET RESTOR. GRADING SAN SEW TRUNK * SEWERLATERAL 1872 1,304.00 52.16 25 WATERMAIN * WATER LATERAL 1972 WATER AREA STORM SEW TRK STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. BUILDING PER. SAC PARK ?:(11 I. 01N(I G17Y OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: r? { 3.'r•r; Eagan, Minnesota 55122-1897 Date issued: (612) 681-4675 SITE ADDRESS: APPLICANT: i' 1 R.' [yAltMf 't [1R ? ( f)AI2 li{tiiVl' # I PERMIT SUBTYPE: , . ..,. RTEiliT WiIY Rt'1??1= l N?3 (Wi,J.: ) fSfi'i-AHAR TYPE OF WORK: RE PA.TR Ow Sr.HtP7 rrrN i. s?. aPFKc?«I INSPECTION DA . D• , . • ?,?. ?. ---------------- ----------- Permit Holder Date Telephone M PLUMBING H VAC Inspection Date Insp. Comments FOOTINGS FOUND FRAMING ROOFING ! D L fivW ROtSGH PLUMBING PLBG AIR TEST ROUGH HEATING GAS SVC TEST INSUL GYP BOARD FIREPLACE FiREPLACE AIR TEST ' FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL aOMESTIC METER IRRIGATION METER FLUSH MA4(VS CONDUC7IVITY TEST HYDROSTATIC TFST BSMT R.I. BSMT FINAL DECK FTG DECK FINAL RESIDENTIAL BUILDWG PERMIT APPLICATION CITY OF EAGAN l ? 3830 PILOT KNOB RD - 55122 651-681-4675 New Construction Reauirements • 3 registered site surveys showing sq. tt. oi lot, sq. ft. of house; and all roofetl areas (20% mmimum lot coverage allowed) • 2 copies of plan showing beam 8 window sizes; poured (ound desiqn, etc.) • 7 set of Energy Calculations • 3 copies of Tree Preservation Plan li lot platted afier 7i1193 • Rim Joist DeGii Options seledion sheet (bldgs with 3 ar less units) DATE i JOB SITE ADDRESS ?/ IP MULTI-FAMILY BUI PROPERTY OWNER TYPE OF'WORiC APPLICAN T ADDRESS PAGER # _ FlREP4ACE(S) _0 7 2l/ 3 PHONE # 391 ' JJIl ZIPCODE AS.S FAX # V9`3 NEW RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1 (check one) - Residential Ventilation Category 1 Worksheet Submitted - Energy Envelope Calculations Submitted _ MINNE50TA RULES 7672 - New Energy Code Worksheet Submitted Plumbing Contractor: Plumbing System Includes: Mechanical Contractor: Mecharucal System Includes: Sewer/Water Contwctor: Air Conditioning Heat Rccovery System All above information must be submitted prior to processing of application. Phone # Phone # S Fee: $90.00 P'ee: $70.00 I hereby acknowledge that I have read this application, state that the inforrnation is correc? and agree to comply i all applicable State of Minnesota Statutes and City of Eagan Ordinances. [?Y ----- Signature of Applicant Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ w CELL PHONE # Water Softener Water Heater No. of Baths RemodeUReoalr Reauirements . 2 copies af plan • t set of Energy Calculations tor heated additions . 1sAe survey for exterior additions & decks • Indicate if home served hy sepUC system for additbns (EXCIUDWG LAND)?? Phone #: Iawn Sprinkler No. of R.I. Baths io-??-d/ Updated 1l01 v EAGAN TOWNSHtP BUILDING PERMIT -- Ownex ...... U!-.--'?^".^'.f.-_.......... Address (Preseni) ._ Suilder Address ...... N° . Eagan Township Town Hall zoss ? Date . ?...L y-lG? - ---- ----'---- SSaries To Be Used For Froni Depih Heighi Esf. Cosf Permii Fee Aemarks 1 s / .4? This pe:mit does not au3horize the use of sixee2s, zoads, alleys or sidewalks nor does if give the owner os his agent the righ! So creafe any situafion which is a nuisance or whiah presenis a hasard !o the healih, safely, eonveaienca and general welfare !o anyone in ihe communily. THIS PEHMIT MUST SEEP?T /ON-?T-?H-E? PREMISE WHILE THE WOAK IS IN PROGRESS. This is lo eerlifp. Yhai.... ....._!.'..:`....`?.....-_-_-------__-.-----_-.has permission !o ereat a----- .... ............. .. ....................... _upon the above deseribed premise subjec! !o the provisions of the Building Ordiaance for E an To nship adopfed April 11, 1955. _"_._'..._._..'_.._'_. ..:. "^.._. ... ?L.`..:......`......."...."........ Per ---- .__.._ Chairm?f Tnwn Board ? $vilding InspecSor ' 4 ,s3 ` " LOCATION EAGAN TOWNSHIP n BUILDING PERMIT o wne: ....---...f!.v..'^".""....?L.:....?.?.?. ....................................... Addresa (presen3) .....f!....c`...........G?r:.._< .............' Builder ....... Addresa _.... DESCRIPTION N° 1798 Eagan Township Town Hall Dale ._C?. ....................... 5Saries Ta Be IIsed For Front Deplh Heighl Est. Cos! Permii Fee Remarks ,?,'C,,?,?,,,?,_, I c ?-o ,?to?-o ')• r% LOCATION This permit does aoi aufhorise the use of slzeeis, zoads, alleys or sidewalks nor does i! 9ive the owner or his agenS the zigh! So creaie anp siluaSion which is a nuisance or which presenls a hazard fo the healfh, safely, eonvenience and geaeral welfare 2a anpone in the eommunifp. THIS PERMIT MUST BE EPT ON THE PREMISE WHILE THE WORK IS SN PROGRESS. • ? This is !o cezrify, thai..... 6Z.-Z-;1 ----- ..................has pormission !o erecf a...........-r.?'!...?...?...?..°..`.?....................... _upon the above deseribed premise subjec! 1o the provisions of the Building Ordinanee for Eagan Township adopfed April 11, 1855. F?!:..------"-"_...... Per ...................... ?....... ?'9"-'.. - ----"----- ' J Chaiffnan of Tnwn Soard Buildin Ins ecfo-s 4,13 EAGAN Tovvrv s Hi P BuiLDiNG FERM'T ? Owne / Addrees (P=esen!) -- °-- -?.f.. ----- Builder ..--....................... /'. _i?t.--- Address ._....----------°--°--°-------------------------. -' ? ----- ......... .......- DESCRIPTION x? _ 408 Eagan Towaship Town Hall Dale ----""----....... Stories To Be Used For -`? Fron1 Depih Heigh! EsY. Cosf ? Permsi Fee ° ? Remarka _ y LOCATION 61a5 - ? This permii does noi avlhorize ihl" use of sireels, roads, alleys or sidewalks nor Zkoes ii give the-b?wner or bis egeni !he xigh! !o ereaYe anp siiuafion mhich is a nuisance or which presenfs a hazard !o !he healfh, safefy, eonvenience ar.d general welfa=e Yo anyone in fhe eommuniiy. THIS PERMIT MUST B,rE? K?E1PT pc?N THF?. REMISE Wf2ILE THE WORK IS IN PAOGAE,S,S-1 /,, t? This is io cezlitp. Shai4f.?-------has permission !o execY e7 E:?'?` .................... upon !he abte descxibe ' u jeci fo !he pxovisions of ihe Building Oxdinance for Eagan Townsh[adopied Apri] 11, Per ......... _........... .........--------°------------------------- Building Inspee!os 16414239288 Fireplacecs & More 16414239288 City QI-Eagan 3530_.Pilq??yp?Rn?dFn?_MN ?5122 Telephone # 651-675-5675 FAX 4 651-675-5694 ?. ???.C? l??k?A-?, 2087 ? R?IILIIIN?ir-PEIF?'F ekPP?IES1T10N p.l NawCanstructi RaourameM 3 reg".IIeretl sle surveys shm?ine sq. R d M sq R tlf Muse; and all ropT d Renwdel/Reoe'rRmu"remenls 2 plieeU?Omv -- . . areas ¢ . (?inumbt mwmgexMewep} c?¢s oi dan eTpxnng Toolrgs,bearns, jo?a CoI d5uiveYRecd - "' V .L::TI t ?NePerkiFprapeeeA?6niW:iq is fe ba?lase4ertA"siurbe9?ed1 lxdefSnc9YESkWeliensiarinmtedeGdtiNdns ..Sdiyflepeel.: .-.j' ??11 Znpies d pknshowingb?n8w'u?COwskes;pouredfaundtlesign,elc. 7 :AlawrueYJaFa&iRiexs&tleske? 4 Adddbn-lnGr.gfetlw?,y(eygp?sysfem FreB$es?aqesd TreO-Pfes Requked _Y Y ? N. N setolEnergyCalwlalbns - - 3-P-esotTreePle?aEimRanI'kt7@ttrdefie`77t/93 OnateS?icSYtitem. . _;;,y. .;..t3 PortrJais4F?teiLCJqioussalecSiocsheat. {huitlirgsuqM13.c` less unds) Minrregasm mechanicei vuntilafion form Raie142 i 07 Site Address K?-. rreperity oa¦eF ("^nf CIOC ??LLV1?? / l ?? kddft? smax k.r N D,,-e -1` t/e K z`- = ?E ? ?Y. f-RY- r,e ?539-€, ??a?,t9s'? 9¢z -S7q? a.vMr1L=1E TNIS AREJt ONLY IF CQH$T?KCnNGA NEW BU/LDING Energy Coxfe (:ategory `N%Mr,°`° RUI"=7671 Calegapr-I Mi?sotx Rules 7672 (,I Rasidenlial Veffiletion Cataypy.l Nbrkshoaf . New Epxgy Cotla NbAStreat ow.^..-d 34dmfdlb3tl . ? EuergpEme?pe.d.k,wEFwrsSu6?. In the Smt12maMF?: Sins ffie C7TY oF Ea9m7-+ssv? PertrnT for asifrnTarplan based on a m45fer iIcfn? Licerrsect:+?rribtv +CAechanicateorstractor - SeoverfWaterCo/Mnhc'Por- Terep3iarne hr( Feie,?lkf . Teler? #f ?. I herebY aAP1Y for a Residential Building Permit and acknowledge thaY the informadon is complete and accur tc; dutLt1e-151atkL.4Y1If' IILCnnfnrmanrr Kal1.Ylle-oidinanrec 811iLCOdC?Qf the-Cily of Fn?an eIId thp StaYe?Of IbiN Statutes; I understand this is not a permit, but only an apptication Por a permit, and work is not to start wifhout a ne ;+. that]l?f--wodL-wiil and a roval of plans. X - ,&P#AWa4W, UniVSte # PERMIT CITY OF EAGAN 3830 Pi!ot Knob Road ?agan, Minnesota 55122-1897 (612) 681-4675 PERMITTYPE: BuzLozNc Permit Number: 0 3 3 2 6 B Date Issued: 0 9/ 16 / 9 8 SITE ADDRESS: P.I.N.: 10-16700-290-02 2142 GARNET DR LOT: 29 BLOCK: 2 CEDAR GROVE #1 DESCRIPTION: r?._. T . o . & etu?.ldi'ti?q Permit Type 13 P1ualding-Giq,rk Type e'rtsus C'ade°*' ? z ?t i JY . . . ?. ?4? ? ? t <?' REROOF STORM DAMAGE REPAIR 434 ALT. RESIdENTIAL q ,'`-J?`4?4..a ? 8R ?lg?`pj•.?i_?t ?k ?i?i?i?.,??'??", ( L' e?l ?I i REMARKS: FEE SUMMARY: CONTRACTOR: - RIGHT WAY ROOFING 1200 E. 79TM ST BLOOMINGTON MN (612) 853-0049 Applicant - ST. LIC. OWNER: 18530049 ?0039999 KLATT BOB 2142 GARNEI' DR 55425 EAGAN MN 55122 (651)454-2ua8 ? I hereby ac(??ipwledge,that ?nfarmatiisn =?s E`cor`"weat aric ? . Statuxe& and,._Ci,, y :a#' ?E?g_n I have read ?h9,ra apP: lioa?itan a.nd. stm.te .t.hot the I 'agree""to` com11 ply t.?ith a1S appca`B1e' State of Mn. ' Ordinan op;s.?,? APPLICANT/PERMITEE SIGNATURE IS UED BV: SIGNAT RE 1998 BUILDING PERMIT APPLICATION (RESIDENTIAL) CITY OF EAGAN 3830 PII.OT KNO; RD - 55122 ? q- O New Construction Reauirements ? 3 registereE site surveys ? 2 copies of plans (inGude beam 8 window sizes; poureC fnd. design; etc.) ? 7 energy pleulations ? 3 copies of tree pmservation plan H lot platted after 711193 required: _ Yes _ No DATE: C")S'Q% DESQRIPTION OF WORK: ?'OIZ?L , S?"IT?YYI I? RemodeUReoair Reauirements • 2 copies of plan • 2 site surveys (exterior edditions & decks) ? 1 energy calculations for heated additions CONSTRUCTION COST; W 3q I bo STREETADDRESS: aILIa t?pCxffUL+ I?r• _ LOT: a(? BLOCK: ? SUBDJP.I.D. #: ---C Q &QA1` (LYLJ `e PROPERTY OWNER CONTRACTOR ARCHITECT/ ENGINEER Name: IC10111 ft &IJ Phone#: GIsU'90R Lsst Firs[ Street Ciry E?l'CI)(\ State: MY) Zip: Company: StreetAddress: 1200 L.79th Street Blaomington, MPJ 55425 City r tate Street Address: City Sewer & water licensed plumber (new construction onty): and lot change is requested once permit is issued. License # aM3Qa q Penalty applies when address chang 1 hereby acknowledge that I have read this application and state that the infortnation is correct and agree to comply with all appiicabl Siate of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: OFFICE USE ONLY Certificates of Survey Received _ Yes _ No Tree Preservation Plan Received _ Yes - No Zip: Phone #: Registration #: _ State: Zip: Phone #: ? n ? ? ? ? ? ? a s U T i I I- I I? r I ?i I-If i i 111111 I I_ Lf _ '?I I I I _ TIT FT- __ I I ' I 1 -77' i I i i. I_ I i'?? i i, I I I ' Ta_ -ri 1-77 I _ i i f 7? T `?i _, - .? ? ? I I L - ?T? LT ? i r ?? rrr LII ??_ rI I . i I I I 1 - I I ?? I i i I y_I I'i I f I I I I I I i_ _I_ I__ I I- I I ? I I I I I_ I .? II I - I I I n r i r f I r ?? ?" ?i i - I I f I I??I_ _ ? - I i F i Tf ? ? F rr r i i - - ? r i - T? i, t r? i ? ?? I In- ? * r ? ? r r _ ?r - -y _ i'? ?- :-- i-r r F -r ? i* i ? i i -iT i• i - . i i L.i - ? i , ? 1 p+-?- 4 - _- _ ? - ? ? ? __ ? ? _ ? ? rt T - -?-FI- ? ?- i I. - I T I • L_ ?. 'T I r i I_I i. T?. i i - I TI-i i iT f L i IT I fT'= - 1 . I I' i_ I i I ? i.i t i ? lTr Fr ? I I_ ? I I I I I i T-1 - T I ? 1T? -7 i i- ? ?? I? ? ? T[ ? I? -T L _?? F I- --f '- _-I-? I CI- ? rr ' 1 1} ' I _ I I ? . - ' f. f?f- 'r?-r i I ? _? I I I I ? ?I I T?f I r 7 I 1i ? r j i j. i I TI I I? _ ? _1Tj -r l iT? _ - . i i I i I I i I, I I I ? I I I I ? I? I I ? i I Z I ? II f I I I _I 1 ' ? I I I I ?. I ? I I? I I L I ? I I ? I I I I r T T I I I 1 i I i. I I.I I - I ? I I ?I F. - L, I ? II i F - ?r r- I I ? II -rr t II_, i ^r -L " -I I - _ I11- f 117T ? TI ? 7? ? ? ` -?' T -F I I ? L IT E r TI - ? i- ? ? r T i - Q F ? -r- i -r-- - - r - i - I I- i - ? i I T L - i T " I ?- fT ?- t ?j rr ? i i I rC I ? ' I I . I 1 ' 1 i I I I i I 1 ! I ? r I I ? I i ? I i ?. I ? I I_ I ' I I I I I I _ I, I I ' I I' I I I I I L I I I_ I - i 1? ' ? !T i i T i( ? - 'T? - - -. f'_I_ -_F" ' i - i I i I r ^ . I II i I III I ' II I I• I I II I I ?I' ? 1 - rT ? ? ?- i ? ? l I . -i I I r ITI I TI? I _ -IT i I' F _ i ? iI I ( i T-?I I . 1 I I I I I. I I I _ I 1 ? k ? ,_ ?--1- m - + - -1- T ? IT ? f ' ?1 ?? - ? ? ? I ? r ? ?? ? ?- ? T - - T r - -? - ? _ . ? ? = ? ? -+ ? _ - 1 i i ' ? i i I ? ?- F ? ? ? I I - - ? i I I I_ •-r_ I I_ ?rrk l r i ?1 ? ? ' L I I i I i i I I I ? I I +1, I' i ? I? ? ' I. I? n - _r _ _ f T f i -n? . rr_ - r r rrrr _ r1 ?! . T i_ I ? ? i i i - L i ? I I - ?_ t_ _ i - - _i ? 'i I i i i ? i' I I_ I I [ _ ? i I?. I- ; I f I I r -i :! T i _y i± _ I - I I - I_I I ? I I i ' ? i _'i i_ ? -- r- -I I - r - - _ i r - _ _ i - I - r - ? i- - rn ? - ? ' I I I 1 I - T I 1 1 r I ? I ? ? I I I ' I I I I . I I ? I ? ? .? ? I I I 1 I I _ _ I ? T ? ._ f , - ' I rI r T _ I _i..?_? - i I " I Trr I I 1 ? r , I ? I ? _I? ? I _. ?1 ? I I I I I I i I ? ?j I )_ I I I i r-? ' ? L . ? ? I + __ ? r I - - - r r - -?- , I i? ?hii I = ?T I ? } I - - -? - - __ - - i I _ 7 -i L? _L^ TI I T? I I {- I - f r I r - ? f i - i -r L ?t { ? rl I I 1 -? I - [ -? I I I , -Ir 0 m a m ? N ? ? ov m m ? n w v n d o m m n m m v n w - o m m n e n v m w - N N N N q ? ? - ? ? ? ? ? - - ? i G ?+-- ? . 0 ? ? - s / . . ,, ? ,? . • ?; e ? 01 J-% IiN ,F ?/- 07 ? 9 C' G L_-- I . 2006 RESIDENTIAL PLUMBING PeRmiTaPPUC,aTio - ? CITY OF EAGAN J 3830 PILOT KNOB ROAD, EAGAN MN 55122 651-675-5675 Please complete for modifications to existing residential dwellings. Date j o 1_ I _4 I ? ? , / Site Street Address `t ??ClrF7.'P? Lt. Unit # Property Owner ?1Q( ? ¢?,??, ? Telephone # ( 6? 1 45 4"2TI (1 Contractor Telephone# (7oSk) I3q6 Address 31old City State? Zip / The Applicant is: _ Owner V Contractor _Other Septic System _ New _ Refurbished Submit 2 sets of plans and MPC license Includes County fee $ 100.00 Per as-built $ 10.00 Alterations to existing dwelling $ 50.00 _ Add plumbing fixtures. This fee includes installation of a water softener and/or water heater at the same time. !f you are installing onlv a water softener and/or water heater, do not complete this section; move to the next section and check the appliance(s) you are installing. _Septic System Abandonment _Water Turnaround (add $130.00 if a 5/8" meter is required) Other: W Water Softener , ? ater Heater $ 15.00 _ new ? replacement Lawn Irrigation _RPZ _PVB _new _repair _rebuild $ 30.00 State Surcharge $ 50 1? 'SO Total $ I hereby apply for a Residential Plumbing Permit and acknowledge that the information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and the plumbing codes; that I understand this is not a permit, but only an application for a permit, work is not to start without a permit and work will be in accordance with the approved plan in the event a plan is required to be repewed and approved. ApplicanYs Printed Name Applicant' ignature -HV PERMIT City of Eagan Permit Type:Building Permit Number:EA113580 Date Issued:09/05/2013 Permit Category:ePermit Site Address: 2142 Garnet Dr Lot:29 Block: 2 Addition: Cedar Grove 1st PID:10-16700-02-290 Use: Description: Sub Type:Reroof & Siding Work Type:Replace Description: Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar. Pictures are not acceptable in lieu of inspections. 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. 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 - Robert M Klat 2142 Garnet Dr Eagan MN 55122 Minnesota Exteriors 8600 Jefferson Hwy Osseo MN 55369 (763) 391-5514 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA149740 Date Issued:06/07/2018 Permit Category:ePermit Site Address: 2142 Garnet Dr Lot:29 Block: 2 Addition: Cedar Grove 1st PID:10-16700-02-290 Use: Description: Sub Type:Residential Work Type:Replace Description:Air Conditioner Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State 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 - Robert M Klat 2142 Garnet Dr Eagan MN 55122 (651) 454-2418 Wenzel Heating & Air Conditioning 4145 Old Sibley Memorial Hwy Eagan MN 55122 (651) 894-9898 Applicant/Permitee: Signature Issued By: Signature