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1573 Mallard Dr po 9d Use BLUE or BLACK Ink ~ l For Office Use I City of NOR Permit#: I ~ Permit Fee: n ac) 3830 Pilot Knob Road Eagan MN 55122 RECEIVED Date Received: Phone: (651) 675-5675 Fax: (651) 675-5694Staff: 2010 RESIDENTIAL BUILDING PERMIT APPLICATION Date: ' t'I Site Address: I J -7 3 1 1l O L~ Tenant: Suite RESIDENT / OWNER Name: 1 1 Phone: 1 - AL17 - 67/a 41 Address / City / Zip: 15 1 1~) 1 Jh~1)l1Z ~.~Orl~. n/~ Applicant is: Owner Contractor TYPE OF WORK Description of work: ( V I .foul - )J6 Ax c Construction Cost: :500 • Multi-Family Building: (Yes - / No } CONTRACTOR Name: f License Address: 41 I City: State: N1 N Zip: sso 1 Phone: &S! - -794- 2-~ `-f ,ID Contact: Email: COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? j _Yes _No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that the are trade secrets CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.ctopherstateonecall.org I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that 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. x J 46 X 1 IJJ4--, d"V, Applicant's Printeil Name Applicant's t nature Page 1 of 2 Use BLUE or BLACK Ink Feu Office Use j Permit I City of Eap I Permit Fee: 00.0 0 I 3830 Pilot Knob Road I I Eagan MN 55122 i Date Received: Phone: (651) 675-5675 1 Staff I Fax: (651) 675-5694 1 I 2011 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Unit n Name: , S 1M &A S Phone: ip RESIDENT / OWNER Address / City / Zip: , 6g3 YY14,~~GY L~ e .,e C n 55) as Applicant is: Owner Contractor TYPE OF WORK Description of work: a LA Construction Cost: ~1 Q u Multi-Family Building: (Yes / No L Company: Q_bb\pfiniLy\ Co4thdihn C Contact: CONTRACTOR Address: I' tiS H &-Y hb r LA rj al _ City: A)L4h0h1k~-h State: 1M N Zip: Phone: 10 Ucense __DO to ~'i 5A^ - Lead Certificate Q 0 13 - 1 b - 00 0 u If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Fagan issued a permit for a similar plan based on a master plan? _Yes No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: NOTE. Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that the are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-=2 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www. o herstateonecall.or I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that 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. x x Applicant's Printed Name Applicant' Signature Page 1 of 3 v00 owe v1 GL A%0r% 111K K ~U I For Office Use _ o Y O1 Emn Permit Nn City 1 I Permit Fee: 3830 Pilot Knob Road l 1 Eagan MN 55122 j Date Received: Phone: (651) 675-5675 i Staff: ~_x7 I Fax: (651) 675-5694 1 1 2010 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: S ` Tenant: Suite RESIDENT / OWNER Name: S . Phone: L,! 0J4 5 ( ~ Address/ City /Zip: -T3 5ma:6,. MN) 5S a Applicant is: Owner Contractor TYPE OF WORK Description of work: - V1rJ rln Op \j 4D (3 2 Construction Cost: 3, ~ ryr) • Multi-Family Building: (Yes / No CONTRACTOR Name: . License i r7 -C S ,a Address: 0j _,Q City: V -7 Stater Zip: Cso Phone: 4,f)) L-149 Contact: Email: COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? _Yes _No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: NOTE. Plans and supporting documents that you submit are considered to be public information. Portions of the information >may be classified as non-public if you provide specific reasons that would permit the City to conclude that:the are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gor)herstateonecall.orci I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordina ces and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a p rmit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. x x Applicant's Prin d Name Applican ignature Page 1 of 2 SEWER & _YVATER PERMIT CITY OF EAGAN 3830 Pilot Knob Rd. Eagan, MN 551 22-1 897 • • --? .? 4 q DATE, " ? METER # OFFICE USE ONLY PERMIT DATE * z CHIP # PERMIT # - METER SIZE B.P. RECEIPT # ' 15SUE DATE B.P. RECEIPT DATE - PRV _ BOOSTER PUMP SITE ADDRESS LOT ` BLOCK ? SEC/SUB ` '°mas r<Rke ?locA : APPLICANT: Jos e D'n ?1 , l' ? 1 1 or r e? 't s t_ - rlc ADDRESS: ' 133 Cedar :?.?r „?, , CITY,STATE 21P,'.' PHONE: ' . t PLUMBER: ? ' nz -TRven ADDRESS: .= 74 S Sn 't o i•? ? t •.;)U . `r. ?c;-,-,? CITY, STATE On FP - ZIP PHONE: ` OWNER: PERMiT REQl1ESTED x SEWER WATER - TAPS - COMM/IND - RESIDENTIAL x NEW EXISTING Lawn Sprinkler Meters are to be Installed Ahead of Domestic Meters on Water Line. Credit WILL NOT be given for Deduct Meters. I AGREE TQ COMPLY WITH CITY OF EAGAN ORDIMANCES 'I ADDRESS: CITY, STATE zIP ' • I PHONE: SIGNATURE WHEN METER ISSUED PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. CALL 4545220 FOR INSPECTIONS. FOR STORM SEWER PERMITS, CONTACT ENGINEERING DEPT. I _.. . ..._?.__?.._ .. . . :. . .. . ... . ,.. ? .,.._.._ ?.L_ - ----_..? ?.__ --? ?, CASH RECEIPT CITY OF EAGAN? 3830 PILOT KNOB ROAD EAGAN, MINNESOTA 55122 DATE ie 4 ( i FECErvEORO ni ? r I ?- 1?' It, •` ' '?, ?'l ? 1 _ i ? ? f ? 14NIIOUfJT $ . ._ ? ? & DOILARS O CASH tk.CHECK FUND OB.IECT AMOUNT Thank You ;,i ., .,,; BY V 14,14"1 YVhile--PaY- ?PY `-??r YeNaw--Postinp C,opy ? Pink-F'ile COpy ? SEWER & WATER PERMIT OFFICE USE ONLY CITY OF EAGAN METER #Vyd PERMIT DATE 3830 Pilot Knob Rd. Eagan, M N 5 5 1 2 2- 1 8 9 7 CHIP # Q.? ?Z 6-7-f 7T PERMIT # 12204 • METER SIZE B.P. RECEIPT # c 14Q4,: -., ' •; '? 1) 1 `.?' 1 ISSUE DATE B.P. RECEIPT DATE 08/Cf> ? DATE • ' PRV - BOOSTER PUMP SITE ADDRESS PEHMIT REQUESTED LOT ' BLOCK 1 SEClSUB 3'r "?.i a p,? „ - SEWER x WATER _ TAPS ? APPLICANT: ' ) eeoh M. .iiller ''o*is t . Itic ADDRESS: ° 1 3 3 Ced a r Av ?7o CITY,STATEFarTinaton, in ZipZ'i PHONE: -i i _.. ;. , r PLUMBER: `?QRZ "±_ v a n ADDRESS: !? .745 so rtc1,) CITY, STATE ;`? PHONE _ COMM/IND x NEW x RESIDENTIAL EXISTING Lawn Sprinkler Meters are to be Installed Ahead of Domestic Meters on Water Line. Credit WILL NOT be given for Deduct Meters. I AGREE TO,COMPLY WITH CITY OF OWNER: EAGAN ORbINANCES ADDRESS: CITY, STATE ZIP -- PHONE: SIGNA ?e WHE M TER SUE PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. CALL 454- F R INSPE TI . JORM SEWER PERMITS, CONTACT ENGINEERING DEPT. ?n ZIP = D'? $ ? .....--4-.?,»...,.,.;,... f .., ? ,.-. y A??452-29? ?? 11/5/41 CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21 199, Eagan, MN 55121 BUILDING PERMIT PHONE: 454-8100 y (? r, ? Receipt # ' Tobelisedfor ?? ??/C.An Est.Value Date r?CG x ig91 Site Addre9's 1573 NA1.I.ARQ DR Lot A Block 1 SeclSub. THOMA8 LAZE WOW OFFICE USE ONLY Parcel No. occuPancy 1-3 1'-1 FEES PD 1 zoninq ?, W Name J?E? M ??A CON3TRliCTI011 (,,,ct„ai) Co„St V-I?11 Bldg Permit 647.00 3 Address 18133 CEDl1R AYE S (Allowable) V'N . pp s? p City F?i?`? Phone 431-2001 # of stories ?i Surcharge Plan Review ? ?20?? Length i cy Name bAME Deplh ? SAC Cit 1?•? = , y OU 4 Address S.F. Total - 00 650 ? SAC, MCWCC • City PhOn@ S.F. Footprinis _ 6W.00 ? On Site Sewage _ Water Conn ? ame on ste wea 95•00 x ji' Addr eSS MW CCSystem x - wacer r?nete? ? a it?/ PhOn@ Ciry Water ? Aoct. Deposit .? ; oo ? PRV Required SNV Permit . I hereby acknowlege that I have read this application and state that the Booster Pump - S/yy Surcharge •50 iniwmation is correct and agree to comply wiih;all applicable State of Minnesota Statutes and City of Eagan OrdinanCes. Treatment PI 276•00 Signature of Permitee ? ? '•' ? APPROVALS Road Unit 370•00 A Building Permit is issued to: J EtH M MILI.BR COITST Planner - ParktDed. on the express condition that all work shall be done in accordance with all Council applicable State of Minnesota Statutes and Ciry of Eagan Ordinances. gldg, pff. _ Copies 3,JZ9.S0 Building Oflicial Variance - TOTAL Permit No. Permk HOlder Date Telaphone #t MVATER p??0 O (l 9? ? . SEWER • PLUMBING 0 H.V.n.C. E ELECTRIC 94 ? Inspection Oate Insp. Comrttents Footings I fj v Foundation Framing Rooting Rough Plbg. Rough Htg. q-(fj--f Isul. _/31G1 LQL? Fireplace Final Hig. , W Orstat Tesl O . ek Final Plbg. Plbg. Inspector - Notity Plumber Const. Meler Engr./Plan B1dg. Final Dedc Ftg. Dedc Final l? ' ' -• . Weil Pr. Disp. Al 3 3..*+ DATE: AUG 6, 1991 RE: 1573 MALLARD DR (JOSEPH M MILLE& CONSTRUCTION INC) X . _ YoU;Aewer & Water Permit for the above property has been campleted. It will be held at the flublic Works Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO wCALL PUBLIC WORKS (454-5220) FOR YOUR PERMANENT WATER TURN ON. Your Sewer & Water Permit for the above property cannot be completed for the foliowing reasons: Your Sewer & Water Permit for the above properry has been completed, but the meter cannot be issued or occupancy allowed until fuKher 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 UTILITIES - TELEPHONE, ELECTRIC, GAS, ETC. - REQUIRED BY LAW. CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY. Secretary, Building Inspections Dept. _a :- (Ctxfi#tratt nf Mrrupanry . ., Citp of (Eagan lotpMrwPtIf Df llTetltg jIiS.pPttm This Certifrcate issued pursuant to the requiremenu of Section 306 of the Uniform Building Code certifying that at the time of issuance this structure was in compliance wi[h the various ordinances of the City regulating building construction or use. For the foUowing.• Uu Ciaaifintion SF ??IGAR Bldg. Aermit No. IAS IS o-„pi-,, T,pe RM11 zon;,g Maicc Pd/R 1 Tya co- VN owner ot' ewld;ne MSEPH M MfT7F.R MM -_ pddre% 18133 iEnAR AVE S, FARMIMMM &,;ld;ygAdd= 1573 MAIIAED) DRIVE B1, IliQMAS IARE WOmS ? / D„e: 10125?q 1 - Building _? - -- POST IN A CONSPICUOUS PLACE ?'A xess: ?573 MAI,LARD DRTVE Lot 4 Blk ? Sec/Sub g?q.?q,q iAi?t WppDg These items were/were not complete at the time of the final inspection. 10/25/()l Yes No FinaL grade (6" from siding) LI_I? Permanent steps - garage Permanent steps - main entry ? Permanent driveway ? Permanent gas ? Sod/seeded grass ? Trail/curb damage Porch V/ , Basemant finish ? ? ? Deck Please verify with the builder the removal of roof test caps from the plumbing system and the shut-oPf o£ water supply to the outside lawn £aucet before freeze potential exists. ?rccmEOwrtx White - City copy Yellow - Resident copy Pink - Contractox copy CITY OF EAGAN (VO 19518 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 BUILDING PERMIT PHONE:454-8100 Receipt # l P' d f i I `T ???.L991 l L? 7obeusedfor SF DWG/GAR Est.Value $102,000 pyte AUG 2 ,1991 Site Address ' 1573 MALLARD DR Lot 4 81ock 1 Sec/Sub. THOMAS LAKE WOOD Parcel No. w IName JOSEPH M MILLER CONSTRUCTION a Address 18133 CEDAR AVE S City FARMINGTON phone 431-2001 o Name SAME g? Address City Phone I Name Address City Phone I here6y acknowlege that 1 have read Ihis application and state that the informallon is correct and agree to comply wah, Ilap hcable State of Minnesota Statutes an,drCiry of Eagan Ordi~ OFFICE USE ONLY Occupancy R-3l'I--l FEES Zoning PD R_i (ACWaI) Const y.cBldg. Permit 647_ nn (Allowable) V-N 51 00 # ofscones Lenglh oeplh S.F. Total S.F. Footprints On Sne Sawage on sita wen MWCC System Cny Water PRV Raqwred Booster Pump Signature of Permitee '" rrnvv A Builtlmg Permit is iscund tn: J SEPH M MILLER CONST Pianner on ihe express condilion that all wor shall be done in accordance with all Council applicable State of Minnesota Stetules and Cay ol Eagan Ordinances. gldy, pff. Builtling Ollicial I n h91811 lf? I Variance ? Surcharge - 571 Plan Rewew 420. 00 46' snc, ary 0 100.0 - sac,MCwcc 650.00 WaterCOnn 660.00 - Water Meter 95.00 ? X Acct. Deposil 30_0 n ][_ SNJ Permit (1 30.0 - 5/VJ Sumharge _ Sfl Treatment PI 7 7 F- nn aoaaunrt 370_0 n - Park Ded. Copias - TOTAL 3,329.50 1 3?? ° p 52247 -??L / _? ° ? Aequest Dale n Fre No NOUQ/2X Q?L 9 1999 Rough-in Inspeciwn Reqwrea' " ?ReatlyNaw ??^tR tlspector . / _?g G N. ea Y I1; ce sed contractor D owner hereby requesi inspection of above elechical work at: Jo0 Atlaress (Street Bov or Route No I Ciry 9573 P1a$2a2d [72iue (E¢y¢a SacLOn No Township Name or No Range N. County i -- t7akota -- - Occuoant(PRINT) Phone No aoe Il Komeh 431-2009 Powe,spPale, noaaeu4300 220th St. S.W. /7¢kot¢ E2ect2ic %¢2mtnyion,l7N 55024 Elecmcal Comraclor ICompany Name) Contraclor's License No l7idPancl Uec#uc 049610 MeiLng Aatlress COnvactor or Owner Makmg Installation, 7630 9451h St. Gl. #214 Rpp-ee V¢Q$ey,11N 55924 awnonrea S, Gomr r Makmg Instailalion) PbonaNumber _ ? 432-6688 MINNESOTA Si/TE BOARU OF ICITY THIS INSPECTION REOUEST WILL NOT Gnggs-Mmway Bltlg. - Rao BE ACCEPTEO 6Y THE STATE 60AR0 1821 Universtly Ave, SL Pa N 55104 UNLESS PROPER INSPEC110N FEE IS Vhone (612) 642-OB00 ENGLOSED REQUEST FOR ELECTRICAL INSPECTION ? See inStmcLOnS (pr comDlervp this lortn on back oi yellow copy ?rl ?`J a 7 "X" Below Work Covered by This Request y 7119 ew kdd Rep. TypeofBuiltling AppliancesWired EqwpmentWired Home Range Temporary Service Duplex Water Heater Electnc Hea6ng Apt Bmltling Dryer Other (Specdy) ? CommJlndustrial Fumace Farm Air Conddioner Othar(sVaaty) ConvaotorsRemerks Compute Inspecnon Fee Below # Other Fee # Sermce EnirenceSize Fee # Cvcwts/Feetlers Fee Swimming Pool 0 to 200 Amps to 700 Amps Transformers Above 200 _ AmpS Abov Amps Signs Inspaclor's Use Only. TOT?A2L Irngation Booms ? ? ? .7CJ? Speaal Inspecuon . Alarm/Gommunicatwn THIS INSTALLATION MAY BE ORDERED DISC NNECTED IF NOT Other Fee COMPLETED WITHIN 18 MON 0 I, ihe Electncal Inspector. hereby R°°9n-io ? j o: f? certrf that the above ms ecAOn has Y P been made Finai --i ? ? Oate OFFICE USE ONLY Tnis reQVesl voia 18 montns Irom ' -' 0 1796 / ,.% e ReQOest Dale 8-26-91 FireNO. Hough-in Inspeclion Reqmretl' T,?. E N. ?PeeOyNOw Q,111004111111,ry Inspector When Peatly' I_P'llicensed coniractor 71 owner hereby request inspection ot above electrical work at JobAtltlfeT ?lt a°WA`t`Y7XVD DRIVE Ci" EAGAN Secnon No Townsnip Name or No Range No Counry DAROTA °"°Pan"JPb , t ' MILLER CONSTRUCTION PnaneN612-431-2001 `OWe`s°b'AKOTA ELECTRIC Atltlfp55 FARMINGTON, MN, EleC11a1ft ?`VL"WY?°'??"CTRIC, INC. Conrcac??4?a?1N? Ualrn9pInIb"„T?1+MM`"M`Mr" WEST, APPLE VALLEY, MN 55124 AutM1Onzetl Signawr o nOwn Ins Pnone Numlper 61.2-432-6688 IN SOTA STATE BOAPO OF ELECTRIQ THIS INSPEGTION PEOUEST WILL NOT Gnggs-Mleway Bltlg - Room S173 BE ACCEPTED BY THE STATE 60AR0 I821 Unrvenity Ave., St Paul MN 5510C _ UNLESS PROPERINSPEQION FEE IS PM1One (612) 642-0800 ENCLOSEO ?4 REQUEST FOR ELECTRICAL lNSPECTION ??J 4 li? See inslmctions lor complxOng Ihis lorm on back ol yellow copy 5 '11 7 q n "X" Belryv Wurk-Covered by This Request ?Q SC"0? ew tl Rep, TypeofBwiding AppliancesWired EqmpmeniWued Home ge Temporary Service - Duplex Water Heater Electric Heahng Apt. Bwlding er Other (Specdy) Comm /Indusirial urnace Farm onditioner Otner ?syealy) Contreotors fiemarks Compute Inspecbon Fee Below: 0 Other Pee # ServiceEntranceSize Fee # Cucuits/Feetlers Fee Swimming Pool 0 t0 200 Amps Qo /16 0 ta 100 Amps Transformers A6ove200_Amps 100_Amps SigpS Inspecmr's Use Only TOTAL Irrigation Booms Speaallnspecllon Alarm/Communication THIS INSTALLATION MAY BE•ORDERED DISCONNECTED IF NOT Other Fee COMPLETED WITHIN 18 MONTHS. 1. ihe Electncal Inspector, hereby Rough-in ate ?. certify that the above inspection has been made F,,,at h, f OFFICE USE BNLV ? ? This request witl i8 monfis (rom ? RESIDENTIAL BUILDING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD, EAGAN MN 55122 651•681•4675 New Cons W clion Reauirements . 3 registered site surveys showing sq. R. of IoC sq. ft. of house; and all roofed areas (20%manmum bt coverage allowetl) . 2 copies of plan showing beam 8 window sizes, poured found design, etc.) • 1 set of Energy Caltulations • 3 copies of Tree Preservation Plan if lot platted afier 711193 . Rim Joist Oetail Options selection sheet (bldgs with 3 or less units) DATE Watcr Soflcncr Watcr Hcalcr No. of I3aths -S?IT'pE ?A?DD S I S 7J MULTI-FAMILY BLDG _Y ?N TY7E`bF?RK 2IZOcJ-P / FIREPLACE(S) ??,0 _ 1_ 2 ? - '-/ APPLICANT /T' 13 4?L i I"_, STREET ADDRESS / Z Z CITYI?Uryfvl//? STATE ???'ZIP S'S33 TELEPH'ON& 707'09'I CELL PHONE #' FAX # PROPERTYOWNER /`52 rA TELEPHONE# o/ -------------------------------------------------°-------------------°----------------------- COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ yIIVN1:S0'f:1 ItUL1:S 7670 CA'I'4:CORY l MINNLSO'1:A RL: LLS 7672 (d submission type) • Residential Ventilation Category 1 Worksheet Submitted rm NewJUL [ Submitted • Energy Envelope Calculations Submitted ??10 O9 2002 i ?) L? ?' III,? i Plumbing Contractor: ____ Plumbing systcm inclucles: Mechanical Contractor: Mcchanical sy'slccu includcs: Sewer/Water CoMractor. -- Air Condilioniny,• _ Hcat Rccoacry Syslcm Phone # Phone # ree: Crr. $70.00 -------°------------------°-----------°---------------------•--------------------------°----------------------------- I hereby acknowledge that I have read ihis application, state that the information is correct, ond agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordi ? s. ? Signature of Applicanf OFFICE USE ONLY I %?? J'3 RemodellReoau Reauirements . 2 copies ol plan • i set o( Energy Calculations tor heated adAitions . 1 srte survey for extenor addihons 8 decks • Indicate if home served 6y septic system for adcitions VALUATION 12 308'- .57'a Phonc k I.awn Sprink No. of' R.I. 1 Certificates of Survey Received - Tree Preservation Plan Received _ Not Required _ Updated 4102 ???' ? 1991 BUILDING PERMIT APPLICATION CITY OF EAGAN SINGLE FAMILY DWELLINGS 2 SETS OF PLANS 3 REGISTERED SITE SURVEYS 1 SET OF ENERGY CALCULATIONS MULTIPLE DWELLINGS , ft*3 1 COMMERCIAL 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL REGISTERED SITE SURVEYS - & STRUCTURAL PIANS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS 1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS # OF RENTAL UNITS # OF FOR SALE UNITS PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY IAST WORKING DAY OF MONTH IN WHICH REQUEST IS MADE. LOT CNANGE IS REQUESTED ONCE PERMIT IS ISSUED. NOTE: ADDRESSES FOR CORNER IATS - CONTRACTOR/HOMEOWNER M[JST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED. PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED. PERMIT MUST SHOW A LICENSED PLUMBER. To Be Used For: New Home I Valuation: ie5EEE?=-L Date; July 30,1991 Site Address 1573 Mallard Dr Lot ! Block I Parcel/Sub Thomas lake Woods Owner Address City/Zip Code Phone Contractor _7o?Pnh M. Miller Cnnct Tn Address 18133 Cedar Av Rn City/Zip CodeFarmin?ton, 55024 Phone 431-2001 Arch./Engr. Address City/Zip Code Phone # I dZo000 ' Occupancy Zoning Actual Const Allowable # of stories Length Depth S.F. Total Footprint S.F OFFICE USE ONLY -3 M - 'PD R -i V - Nl V- KI ? 46? On site sewage_ On site well MWCC System ? City water L.-- PRV Booster Pump _ APPROVAIS Planner _ Council Bldg. Off. Variance FEES 6q7 OV Bldg. Permit , Surcharge 51,0 ? Plan Review ,OU SAC, City OV 00? SAC, MWCC GSa.o° Water Conn. 66 O.Ov WBteY MeteY S,UJ Acct. Deposit 30,0? S/w Permit o 30,0 S/W Surcharge ?? Treatment P1. 6,0 0 Road Unit O.? Park Ded. Trail Ded. Copies SUBTOTAL Penalty Lot Change TOTAL ? ddA?)-Z" agrees that all work shall be done in accordance with tnL L?= (Signature of Contract ) all applicable State of Minnesota Statutes and City of Eagan Ordinances. i ; 7, • « ?? v?'???? GARa,?e 214 x I I ? 26y -70 ?"3 = ;z bo ao xzz= c?yo 9 /5= I4yGo 13SrrJ -t 3?f X24 : ?1 ? `i ?,1 r?r? _ 46 f 2'?zX Io = Izs /bK/? = l92 _- 1?'lq X ?y = 1650? BsvnT; I'h.?vi : IG I3Z?I X ?3 ? r7bl y37 ?D??yo3 OK I o 2I Ooo'' * 2422 Enterprise Drive - ? PIONEE?y !"f _ lANDSUNVETORS•dVIIENGINEERS - MendOla HBt9IltS, MN 55120 *eng*eering,.. LANOPLIINNEA'S- lANO4CAPCPRCHItECTS (c12) 68 1 - 1n 14 * ? * I` ? CertificateofSurveyTor: - c- h 40MES . ? NoR7H 9 yq'O y?\ \ ? - N I \ 'r'.c M ? M I \ 0 ? \ Z 2 I J'N \ ?s a I \ ? ? /? 9zs.8s > I q?os/VAet R Jc /y y? 0 Q 3 3 9?0. ?N I +A?\•o B?Q•? ??j \/?\ 4L? S' ? qb ?.D 0 \ MN M ?• oQvy? 0? r o• 'f \ ? ?? ?\ 9 9 t Y- 81 S iD U'P 1 'ID? 6 Q"P ??,, ? S a 4L9.9 R6. 'SCU a '?' ? N ,?,e•? ? ? p?: ? ? f. 3SS ? qti? q? • ? ..?. ?6 'B ?P q,? a yz9, G?? '%GI Fl?I1qC D? ? 900.0 Denofes exisfin E7evalion PF20P05E1J NUClSE EL.EVqTIQNB =900.0 _ Denofes propo. d Elevafivn /owes/ F/oor E7eval'ion = Denoles Orairlve eUiili}y Epsemenf Denofes Ora,nc? e Flaw Arraws 7ap at^?IacG E/evolian: 93z, 3? o Denotes monumehf Garcr?e Slab E/evalion= 32•03 Bearirs shawit are assumed Sub,iecf fo Easemen{s of record L07"_4_, BC.OCk` r, TyoMAs . LAklE Wooos DAKOTq COUNTY) MINNE5o1"A ?9?j I hereby cenlly that thls survey, plan or raport was preperad 6y me or unde? ??su er8lsio?E?4?fyV7?ELUSurveyor under the lawf ol 1he Slale ot Minnesota. Deled thls25Wdxy oi J 41n 19-efE . y/ F S ca/e : 1 rnch , 4 o tle / I2A_ i?ttV fR.SiKlf.li _?l:.IJ?.I?N91 a3 q ? ?r?j uuIi,uluu llN:k'IIU'll-ll;ul I I t?t/' c.. , k:A'1'L1t1UI2 EItVLLOF'Fl AVF;liAt1C -IIU II CONPU`PATIUp • ('Po be euhmi:tCed. tivitli Uuildiug permit appliaation) Uno •ar 1'wa F'amlly Dwelllug ONner . All otlier :6fte AddreeB `0-` ,E?- c?u, ' ao?? ( 19PA C) Coutrnotor_,...1^?,? l ?'?•? dD/1)?11 Uate Plione LIIIEAL FEET OF N ? • %` r? ,,7 EXI'OSEU YlALL ??? ?`!('l_ ??•'?l? fts above grade = ?G LJ•??- TOTAL EXP08EU WALL AItEA &q. FT. . ,? . , oPAqUE WALL CoTISTRUC'fIOlf i 'IU" Vatue x Area • . ? ' x sq • , ' ?? Z F?r ? (u)(n) uataii . ,• . reCareuoe i' l R - 8 R• - FT V' Z a ?F2? •_j U A ( )? ? • rro?n wt, ?lull x. liull sq. - e?m. atta?i?aa R aq. FT. Cl iU )(R) ?i?ooto "U" x aQ. Fm. _ (u)(n) , itull x aQ. rr. _ (u) tnl wiuuovrsI "ull vaa.ue x nraa Ilalce & Type WC411 (V ?tY??•y null I?-?n. x 6q. F'1'. .ZoZ•l? ? ZlM (U)(A) IOull x ? aR. FT. = (u)(n) n n npu x BQ. FT. ? (U)(A) n n uuu x 8Q. FT. _ (U)(A) WU1191 "U" Valuo x Area . Ilolca & Type X 9q. u u ' npu x 8Q. n n upn x 8Q. n n npu • x 8Q. xoTnt.s . • nvEi;nUE 11u11 roTni, (u)(n) vnr.uEs ?70,59? .q ? FT. A c.-a (u)(n) FT• (U)(A) F'P. • _ (U)(A) F'1'. ? (U) (A) r"x. (u)(n) UIVIUED UY TOTAI;-?V1/?LL AREAZZ??,,9?,,tj /^? ? AVEUAUE "Ul leue Tor 1&2. fai ly d ' uge ,' . . NooF/CEILIHat ? '10'CAL' A1tEA! Uotail re[ereuae D2/ x 8Q FT. (A). trom ' 11 x 3 F'T. K (U)tA) attached shoete. %lUll x S(?. t F'P. • ? (U)(A) Uaucri6e openiuge ? 'itUll x 8q. FT. ? (U)(11) iu roof. liUll x BQ. FT. - (U)(A) '1'o'P1lL (U) (A) VALUE9 lllVillEll IIY 7o7?t??JrT Z`U?> " TO'PltL Si00P/CEILItIU? A1tEA R ? - AVE?tnaE u!l .025 for veuti].uted ro ?Te;? (_? • . • .. 640-??c.? ., ?,? , ??x ??v? = I 35?z? ? ??j,?z?1?!??z??? . 11? z2u-7 I 3- z?.?c?? = ?f?,?? 1 ? ?'???? z- 21-X -?&ja ^ X12-1 ?_-- ?- V5 ,?,: ? s wI ?,t,, 2°I = 'jOZ r Z? ? I??? ? - __.---- l8oz,z1 -,• --41 Wuuj uiwl uud l;ouu. Uloolc TOTAL (il)e Z?,4i? itooe'/aEiutl9 .1 n vu.u 1.) In6erior Air t'i1m 0.61 z.) 5/011 uxr. na. 156 30 Itieulabion 5.) Exterior Air film .61 tsrzLt,) . apu n I/It? ',? ioT/lI, (n)n ?iS .7$ =- ? WLL ? 6.) Interior Air f'i1W 70 }1"(1yi,. na. 06) zueuletion 9. 10.) Haeonite diug 11.) Exterior Air Film {i VALU 0. 60 • .45 19?oa z 67?. IlUll q ??lla • ??':7 l0'rAL ?n?e zJT.Or ?? . L..• . ?? VALU 12.) IuEerior Air Y'iLn 0.60 130 IneuleEiou Iq.00 140 P-11 Fir tlim JoinC • 1.00 15.1 P?vic:r•?'i7G - 2,04- - 16.) llauoldte oidius 1 667 170 ExEerior Air Film 017 upi? a 1/I1? #04•a FOU11llATIO1( ? 10s).Inberior Air Film' 19.) • . zo: ) ?-?J y 1ktP1?? ' 210 lE'l Uottorete llloolt 22.) ? 23.)rExEerior Air Film pi . Iipn a 1?Ila .^070 ?- : ? ? .' • • ? ri VALU 0.60 1?20 .17 7omnL (tt)p J3.fr? : ? - CITY OF EAGAN FOR CITY USE ONLY 4 ' 3830 PILOT KNOB ROAD EAGAN, MN 55122 PERMIT # PHONE: (612) 454-8100 RECEIPT DATE: PLEASE COMPLETE DPPER PORTION ONLY FOR SZNGLE FAMILY DWELLINGS & TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. ------------------- WORK DESCRIPTION NEW CONST _4L ADD ON _ REPAIR _ OWNER NAME: ?C??. ? \_ SITE ADDRESS: LOT:__ - BLOCK ! SUBD. INSTALLER: ADDRESS: 3bD '6 A? ? CITY: Q,-) ZIP: PHONE (O o - Li) CJ FEES ADD-ON MINIMUM $15.00 HVAC 0-100 M BTU 24.00 ADDITIONAL 50 M BTU 6.00 GAS OUTLETS - MINIMUM 3.00 OF 1 PER PERMIT SUBTOTAL: STATE SURCHARGE: .50 TOTAL: S °?' E n OFS G ATURE RMITTEE OppIIqggCT(l,T;/INb'f1$TPT4;, PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL SUIL?INGS, APARTMENT BUILDINGS, AND MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT. --------°--___-------- CONTRACT PRICE: OWNER NAME: SITE ADDRESS: _ LOT: BLOCK _ SUBD. INSTALLER: ADDRESS: CITY: PHONE #: FEES 18 OF CONTRACT FEE. STATE SURCHARGE - $.50 FOR EACH $1,000 OF PERMIT FEE. PROCESSED PIPING = $25.00 $25.00 PiINIifiJt4 FEE. CONTRACT PRICE x 18 STATE StIRCHARGE TOTAL: (SIGNATURE) ZIP: FOR: CITY OF EAGAN CITY OF EAGAN 3830 PIIAT KNOB &OAD EAGAN, MN 55122 PHONE: (612) 454-8100 ......... . .. . . ......... ?17?5+? FOR CITY USE ONLY PERMIT # RECEIPT N / O e'L DATE: 9 PLEASE COMPLETE IIPpER PORTION ONLY FO& SINCLE FAMILY DWELLINGS fi TOWNHOMES/CONDOS WHEN PERMITS A8E $EQIIIRED FOR EACH IINIT. WORK DESCRIPTION NEW CONST ? ADD ON REPAZR OWNER NAME: JOE MILLER CONSTRUCTION C0. INC. SITE ADDRESS : / S 7 ? ?'?I?` ??,! -?t,?,,v.2? LOT: q BIACK _L SUBD. INSTALLER: 6ENZ-RYAN PLUMBING & HEATIN6 C0. nDDttESS: 14745 South Robert Trail CITSC: Rosemount, MN ZIp: 55068 F<:oNE #: (612) 423-1144 COMPLETE THE FOLLOWING: N0. FI}CTURES EA. TOTAL ADD-ON MINIMUM 15.00 I SHOWER 3.00 ? WATER CIASET 3.00 1 BATH TUS 3.00 :.3 va T IAVATORY 3.00 ? KITCHEN SINK 3.00 i IAUNDRY TRAY 3.00 ? AOT TfJB/SPA 3.00 J_ WATER HEATER 3.00 ? ? FI.OOR DRAIN 3.00 GAS PIPING OUT. I (MINIMUM - 1) 3.00 3dD ?y ROUGH OPENINGS 1.50 .S V oTHER / WATER SOFfENER 5.00 ? _ PRIVATE DISP. 15.00 _ U.G. SPRINKLER 3.00 SUBTOTAL ? ST. SURCHARGE .50 TOTAL: S 3 ? PLEASE COMPLETE TfiIS PORTION FOR AI.L COMMERCIAL/INDIISTRIAL SIIILDINGS AND M[JI.TI-FAMILY BffZLDINGS W1iEN SEPARATE YERMITS ARE NOT REQIIIRED FOR EACH DWELLING tINIT. Y CONTRACT PRICE: OWNER NAME: SITE ADDRESS: IAT: BIACK _ SUBD. INSTALLER, , ADDRESS: CITY:' PHONE # ZIP: FEES 18 OF CONTRACT FEE. STATE SURCHARGE - $.50 FOR EACH $1,000 OF PERMIT FEE. $25.00 MINIMUM FEE. CONTRACT PRICE x 18 $ STATE SURCHARGE $ TOTAL: $ ( S IGNAT[JRE) FOR: CITY OF EAGAN ?1"?' ? ?y Z Nes?i?nf 1941 ILDING PERMIT LICATION cu r/ 6 8 92,5?Lr CITY OF EAGAN ? SINGLE FAMZLY DWELLINGS li[TLTIPLE DWELLINGS G r p i OMMERC? O-, ` 'T ?t h 2 SETS OF PLANS 2 SETS OF PIANS 2 SET9?/OF,ARR?HITEC ?? ? 3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - & STRUCT[TRAL PIAN'I? S? 1 SET OF ENERGY CALCULATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS 1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS # OF RENTAL UNITS # OF FOR SALE UNITS PENALTY APPLIES YHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP SY IAST WORKING DAY OF MONTH IN WHICH REQUEST IS MADE. IAT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED. NOTE: ADDRESSES FOR CORNER LATS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALIAWED ONCE BUILDING PERMIT IS ISSUED. PROCESSING TIME FOR SEWER fi WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN PERMIT M[IST SHOW A LICENSED PLUMBER. ? se ? ? ? ?9l To Se Used For: Valuationn: -577- _ Date: r Site Address [ ??(/ OFFICE IISE ON? ', \ Lot ? Block I Parcel/Sub ?hOLLtA4 ""Ye-P Ivds, owner A.7i /Yla y?5 Address J.5 -7 ? 24 fJqhQ /??^t City/Zip Code ? 5-1 Z3. Phone y 5 z?;2 79 o Contractor h?6 yq e awu PL? Address City/2ip Code Phone Arch./Engr. _ Address City/Zip Code Phone # Sewer/Water Licensed Contr Occupancy Bl g. Y14rm4.t_ Zoning Sur arge Actual Const Plan Review Allowable SAC, City # of stories SAC, MWCC Length Water Conn. Depth Water Meter S.F. Total Acct. Deposit Footprint S.F. S/w Permit S/W Surcharge On site sewage_ Treatment P1. On site well Road Unit MWCC System Park Ded. City water _ Trail Ded. PRV Copies Booster Pump _ SUBTOTAL APPROVALS Penalty Ylanner Lot Change Council TOTAL Bldg. Off. r=US Variance a? agrees that all woik shall be done in accordance with (Signature of Contractor) all applicable State of Minnesota Statutes and City of Eagan Ordinances. PERMIT City of Eagan Permit Type: Plumbing Eaaan, Permit Number: EA097391 Date Issued: 12/13/2010 OR Permit Category: ePermit 41~ it~ of E3 E Site Address: 1573 Mallard Dr Lot: 4 Block: I Addition: Thomas Lake Woods PID:10-76100-040-01 Use: Description: Sub Type: e - Water Heater Work Type: New Description: Water Heater Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments: Kris Oien 3670 Dodd Rd Eagan, mn 55123 651-365-1340 Fee Summary: PL - Permit Fee (WS &or WH) $50.00 0801.4087 Valuation: 848.00 Surcharge-Fixed $5.00 9001.2195 Total: $».00 Contractor: - Applicant - Owner: Champion Plumbing Arlan Jame S Marks 3670 Dodd Rd., =100 1573 Mallard Dr Eagan NIN 55123 Eagan MN 55122 (651) 365-1340 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 Cite of Eaaan Ordinances. ApplicantiPermitee: Signature Issued Bv: Signature Use BLUE or BLACK Ink r For Office Use Q3 Permit 10 E City of EaEd ~J I Permit Fee. 3830 Pilot Knob Road I I Q/ Eagan MN 55122 Date Received: CL Phone: (651) 675-5675 I Fax: (651) 675-5694 1 Staff: 2011 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 10 -27- Site Address: 1573 MA11old 0/,V.- Unit Name: S-Ae d e 'Yyi,c P/ Phone: 70-60-7- 2750 RESIDENT / OWNER Address/ City /Zip: /57-3 11'14(/4/,) ®r 1 45~.(,, 54, M rJ S 5 /o a. Applicant is: Owner Contractor TYPE OF WORK Description of work: Construction Cost: k~, U~ Multi-Family Building: (Yes / No Company: L)r df m4dde t Cejosly✓c A •'cry Contact: CONTRACTOR Address: / 7 75'x-Tccpi ieot, ~ City: tAk Py %lJ-e State: AJ Zip: 4,sU4,l/ Phone: JAI"o~3r/'1~7G License U G 39 5-,~7 Lead Certificate NA a r° 37-~ If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? _Yes _No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: NOTE. Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that 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. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. x ~V i/ ;'7/A;""_ x Applicant's Printed Name Applicant's Signature Page 1 of 3 PERMIT City of Eagan Permit Type: Mechanical Eaaan. Permit Number: EA101906 Date Issued: 11/01/2011 OR Permit Category: ePermit 40~ it~ of E3 E Site Address: 1573 Mallard Dr Lot: 4 Block: I Addition: Thomas Lake Woods PID: 10-76100-01-040 Use: Description: Sub Type: e - Furnace & Air Conditioner Work Type: New Description: Furnace & Air Conditioner Comments: Questions regarding electrical permit requirements should be directed to Mark Anderson. State Electrical Inspector. (952) 445-2840 Fee Summary: ME - Permit Fee (Replacements) $50.00 0801.4088 Valuation: 5.498.00 Surcharge-Fixed $5.00 9001.2195 Total: $».00 Contractor: - Applicant - Owner: Bonfe's Plumbing & Heating KEIKO I TSTE YOUNG 505 Randolph Ave 1573 Mallard Dr St Paul MN 55102 Eagan MN 55122 (61)228-9071 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 Cite of Eaaan Ordinances. ApplicantiPermitee: Signature Issued Bv: Signature PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA150613 Date Issued:07/17/2018 Permit Category:ePermit Site Address: 1573 Mallard Dr Lot:4 Block: 1 Addition: Thomas Lake Woods PID:10-76100-01-040 Use: Description: Sub Type:Residential Work Type:Replace Description:Water Softener 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. Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener). 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 - Steven J Yunger 1573 Mallard Dr Eagan MN 55122 Croix Crystal 3440 Yoerg Dr Hudson WI 54016 (715) 386-8667 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA177751 Date Issued:07/18/2022 Permit Category:ePermit Site Address: 1573 Mallard Dr Lot:4 Block: 1 Addition: Thomas Lake Woods PID:10-76100-01-040 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 - Steven John Tste Yungner 1573 Mallard Dr Eagan MN 55122 (651) 600-8700 Champion Plumbing Llc 3670 Dodd Rd., #100 Eagan MN 55123 (651) 365-1340 Applicant/Permitee: Signature Issued By: Signature