1775 Monterey LaneCITY OF EAGAN Remarks ?
Addition Ridee View Acres Loc 11 eik 3 Parcei 10 64000 110 03
ownerC,dWcrd 5, a+ k-16ppj screet 1775 Monterey Lane State EaQan, MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. 19]] 1418.20 141.82 lO
STREET RESTOR.
GRADING
SAN SEW TRUNK 'fO 1968 100.00 3.33 30 PAID
*SEWERLATERAL& YllU 1972 ZO
WATERMAIN
*WATERLATERAL & Stub 1972 20
WATER AREA
STORM SEW TRK 1'?Z-? 1983 561.00 37.40 1$
*STORMSEW LAT 'h " 19]2 $29]].$0 $148.89 20 PAID
CURB & GUTTER
SIDEWALK
STFiEET LIGHT
WATER CONN. $320.00 8205 6-7-73
BUILDING PER.
snc 9475-00 820 6-7-73
PARK
?
" EAGAN TOWNSHIP
BUILDING
Ownet "-.........T..:...-'---??.._.
a ,
Address (Presenl) --02-19 ..9113 ...
Builder ------- .... l?`--?.`.'.......
PERMIT
Addreas ......................... ---'-'------°'---°--'-°----'-°-.'--'--------..._............
DESCRIPTION
N° 3035
Eagan Township
Towa Hall
ae:e .... (e-'7-73
-••--.................
6tories To Be Used For Fxonf DepYh HeighS Esl. Cosf ermif Fee Remaska
!1 . acr-/ .?,.-?
s u?,e
? a ? /O i ec.
c ? ? .a.t?z?? $,?.
" LOCATION /AS -.S O -
/ 1 I 3 1 44-t-c-
This pezmit does nof aulhoriae the useyof afreaffi, roads, allaps os sidewalks nor does it give ffie owaer or his agen!
!he righifo creale aay si2uaiion which is e nuisance or whieh prasenYS a hasard !o !he healih, eafely, eonvenience and
general weltare !o anpone in !he eommunify.
THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WOAK IS IN PRO AESS.ee
This is !o cerrify. !hal---. Z k ..:....n]? .. . . .............................. ..has permisaioa !o arae3 a.. ... .P.??s:;.??..°.:?,..- -.-.- . upon
ffie above desaribed premice 4ubjec! !he provisiona of !he Suilding Ordinance for Eaflaa Tovfnship adopted April 11,
1955.
...... -._...._?..`....l.::.?._V..?..??Q..-°?,? _---?t`-.'. 1.n? ------ . 1... Per ...._........-------...?17-?'?°--? ::....-°--- .......................
Chairmaa %i Tnwn BoardO Suildin Ins ecfore
ag
//3 a cC9&vi&.J
vzLLnUE 01' r;ncarr
3795 Pilot Itnob Hoad
Eagan, Minnesota 55122
PII?.IvIIT N0. 391
The Village of Eagan hereby grants to Genz-&yau Plumbiog 6 Hea[ing
o£ Roaemount. MN 55068
a HEATlNG Permit for: (Owner) Neppl - Roger Reinhard t
at 1775 Moateraq Lana , pursuant to application dated 7/31/73
Fee Paid: $20.00 dated this 7th day of Auguet , 19 73
.-JU
Building Inspector
Niechanical Permits:
Bid Total:
VILLAGE OF' EAGAN
3795 Pilot Knob x.oaa
Eagan, I4inneaota s5122
PIIMIT N0, 375
The Village o£ Eagan hereby grants to Geny Rvan Plumbinu & Aeating
of Rosemount, PIId .55068
a PLUMBING Permit for: (Owner) Reinhardt (Nappl)
at 1775 P4Dnterey Lane , pursuant to application dated 7/31/73
Fee Paid: $20.00 dated this 7th
.50sc
day o£ August , 19 73.
Building Inspector
Niechanical Permits:
Bid Total:
YILLAOE OF EAOAN SEWER SERVICE PERMIT
3795PilofKnobRood PERMITNO.:
fogon, MN $51$2 DATE:
Zoning: R-1 No. of Llnita: 1
Owner:
Address
Site Adc
Plumber.Genz Ryan ph hi a cLp ating
I agree ro comply with the yilbge of Eagan Connection Charge: 375. 00 d 6 7
Ordinancn. Account DeposiL•
Pernti[ Fee: 10 nn n/9n?7-i
Surcharge: .50 8/20/73
By` Misc Charqes:
Date of Insp.: To[al:
Insp.: Date Paid: _
?
EAGAN TOWNSHIP
3795 Pilot ltnob Rosd
St. Paul, Minneaota 55111
Telephone 454-5242
PERMIIT FOR WATER SERVICE COPINECTTON
Date• 8/20/73 Number• /.;?
//-3 ic-l aVlacJ
Billing Name: Edward J. Neftl Site Address: 1775 Monterev Lane
Owner• same
Billing Fddress -
Plumber: Genz Ryan Plumbinct & Heatina
Location of Coanection Metee-s Connect3on Chg. g?2n..On nd 6/7/73
-? 10.00
Meter No Permit Fee Pd 8/20/73
aa ? / /?
Meter Reading` "?
Meter Sealed: Yes Add'1 Chg.
" NO 1bta1 Chg.
Inspected by
Date
Building is a: Remarks: '
Residence xx
Multiple i,*o. Units 6 ?
' r,.?
.......: ..v?.1Y i,_, t'J!1
Commercial
. . _.. ;t'
•3 I ?)' . . ?
?Il?.
Industrial Hy:
Chief Inspector
Other
In conaideration of the issue and delivery to me of the above permit, I
hereby agree to do tte proposed work in accordance with the rules and
regulations of Sagan Township, Dakota County, Minnesota.
By:
Please notify the above office when ready for inspection and connection.
?`d ? ? ?E?vEa?u???? •
Foster Family Homes
Day Care Homes
TOY
ZONING - NOTIFICATION OF INTEyT
DAK 344
-- -?
.__. _ 1J(City)
mtJ
z?
FKOrt: DAKOTA COUPJTY SOC€aL SEZ'd:,12
(Coun[y ?lelfare I?ag?a?p?, ft, Volun[ary Agency}
-3S-7 94& PW NQ SOUTH ST, PAUL, MINN. 55075
(Street Address)
J (City) (State) (Zip)
APPLICANT:
E'? ---- m ?`1
ty) (State) (21p)
Nuanber of Natural Children under 18 1n home: A 1 2 3 4 5(ae
(circle number)
`7urober of Foster Children included in license: 0 1?3 4 5 6 7
(circle number)
Number of Natural Preschool Children in Home: 02 3 4 5
(circle number)
tlumber of Day Care Ch:ldren included 1n 1lcense: 1 2 3 4 5
circle number)
DATE OF NOTIFICATION:
MASTER CARD
OWNER
STRUCTURE AND
IAND USED AS
Permit
No. ?
Issued I Issued To%
I Owner
Contractor
BUILDING
PLUMBING -
CESSPOOL - SEPTIC TANK
WELL
ELECTRICAL
HEATING
GAS INSTALLING
SANITARY SEWER
OTHER
OTHER I
Items Approved
(Initial)
Date
Remarks
Distance From Well
FOOTING SEPTIC
FOUNDATION 'J.3 CESSPOOL
FRAMING TILE FIELD FT.
FINAL
ELECTRICAL
H
HEATWG
GAS INSTALLATION g:73 DEPT
OP WEIL
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUMBING (•
WELL
SANITARY SEWER
? Violations Noted
on Back
COMMENTS:
COMPLIANCE INSPECTION REPORTS
TO BE USED ONIY IN EVENT OF OBSERVED VIOLATIONS
PERMIT NO.
CONDITIONS OF CONSTRUCTION AT THIS INSPECTION
? NO EVIDENCE OF NON-COMPLIANCE
OBSERVED.
? ACCEPTABLE SUBSTITUTIONS OR
DEVIATIONS.
DATE OF WSPECTIQN
? NON-COMPLIANCE. BUILDER WILI COMPLY
WITHOUT DELAY.
ITEMIZED AND DESCRIBED AS FOLLOWS:
NON-COMPLIANCE. BUILDER DOE5 NOT
IN7END TO COMPLY.
? COMPIETION OF CERTAIN IMPROVEMENTS
WILL BE DELAYED BY CONDITIONS BEYOND
CONTROL.
? REINSPECTION REQUIRED
DATE OF REINSPECTION
REVEALED
CERTI FICATION -I certify that I have carefully inspected the above in which I have no interest preunt or prospectiva, and that I have reported herein
all significant conditions observed to be at variance with ordinances of the Town of Eagan, approved plans and specifications, and any specific requira
ments for off-site imprwements relating to the property inspected.
? ALL IMPROVEMENTS ACCEPTABLY COMPLETED
INSPECTOR
DATE
p,0 L.30 3.s-
I ?o?GVa r? ?. 9L /q f r; c i'a /7? . /Ve//
L 07` // ? Q /oc /S' 3
-- ??"?9 e v?'e w Ac res
--
0
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- 4 -- - - ---- -
?
?
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---- i T -- - -- i T - -
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-- - - - - - - - ? - - ?-- -
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I
Ll Io e4 'J LI'
2004 RESIDENTIAL MECHANICAL PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for. single family dwellings & townhomes/condos when permits are required for each unit
?
Dateo?_ /,2L-
SiteAddress l77S
ren.,
Unit#
Property Owner
! V---?--? ( Telephone # (&JI
Contractor
Street Address
State 57"
Zip '55 w. City ?
?DO Telephone# (IQS? ) J?? O/??
Bond #: Expires:
The Applicant is _ Owner ? Contractor _ Other
Add-on or alteration to existing dwelling unit $ 30.00
? furnace _Additional 2Replacement
air exchanger
? airconditioner \ '
_New YReplacement
other
P?n
StateSurcharge SEP B 3 2004 g .so
Total BY $ 3D
I hereby apply for a Residenrial Mechanical Perntit and acknowledge that
be in conformance with the ordinances and codes of the City of Eagan ac
pSLruit ' but only an applicati on for a pemut, and work is not to start wit
app ov d plan, ^^e ca?e J? woi wlnq? s a review and approval
ation is complete and acctuate; that the work will
Mechanical Codes; that I understand this is no[ a
nit; that the wQrk Will be in accordance with the
ApplicanYs Printed Name
2004 COMMERCIAL MECHANICAL PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for. commerciaVindusVial buildings
mul[i-family buildings when separate permi[s are not required for each dwelling unit
Date / /
Site Street Address Unit #
Tenant Name (if applicable) Previous Tenaot Name
Property Owner Telephone # ( )
Cootractor
Street Address City
State Zip Telephone # ( )
Bond #: Expires:
The Appiicant is _ Owner _ Conuactor _ Other
Work Type
_ New Construction _ Underground Tank _ Install _Remove **see below
_ Interior Improvement _ Install Piping _ Processed _Gas
Nature of Work:
"When installinq/removing underground tank, call for inspection by Flre Marshal and Plumbing lnspector
Permit Fees: $70.50 Underground fank installation/removai . ,
$50.50 Minimum (includes Sfale Surcharge)
or
Conkact Value $ x 1% _ $ Permit Fee
• If ermit fee is $1,000 ar less, add $.50 =1 $ State Surchazge
If ermit fee is over $1,000, add $.50 for
every $ 1,000 ep rmitfee $ Total Fee
1 hereby apply for a Commercial Mechanical 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 with the Mechanical Codes; that I understand this is
not a permit, but only an application for a permit, aod 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.
ApplicanYs Printed Name
Applicant's Signature
Approved By: Inspector
a3
2005 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
6v
?' 7U(--
New Consiruction Rewiremenis RemodellRepair Reouirements Qfhs8 Usg f7R[Y
3 registered site surveys shaving sq. fl. of lot, sq. fl. of house; and all mofed areas 2 copies of plan CerfaFSiwey?Recd
(20%maximumblcoverageallowe? isetofEnergyCakulationsforheatedadditions TtC2FTesPiaiiRecd _KY?I
_
2 copies of plan showing beam 8 window sizes; poured found design, etc. 1 site survey for addiiions & decks Tr?2 ARS Re?itced 7Y
N
lsetofEnergyCakulalions Addfi'on - indicafeBwisdesepticsystem DresiteSepfic?5ystem ....::Y,...:,.N.
3 aopies of Trce Resetiation Plan rf bl platted after 717193
Rim Joist Detail Optwns selection sheef (buildings with 3 or less unils)
?
Date -g -/?/ Construction Cost 9v - e")
Site Address lJ Unit/Ste #
Descriptian of Work ?4?e? /?'JP•JT C/ ? U 4JS
Multi-Family Bldg _?- Y_ N Fireplace(s) _ 0_ 1_ 2
Property Owner P? TR Telephone # ( )
Cootractor -S/z j•ya
Address City
State ,y ? 4--, 0?1 Zip Telephone # (
COMPLETE THIS AREA ONLY IF
Energy Code Category - Ml°nesota Rules 7670 Cateeorv 1
• Residential Ventilation Category 1 Worksheet
(4 submission type) Submitted
• Energy Envelope Calculations Submitted
A NEW BUILDING
Minnesota Rules 7672
. New Energy Code Worksheet
Submitted
In ihe last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_ Y _ N If yes, date and address of master plan:
Licensed Plumber
Mechanical Contractor
Sewer/Water Conhactor
Telephone #(
Telephone #( ?
Telephone # (
I hereby apply for a Residential Building 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 State of MN
Statutes; 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.
Applicant's Printed Name
?
Applicant's Signature
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 OS-plax ? 13 16-plex O 20 Pool ? 30 Accessory Bldg
? 02 SFDwelling ? 08 OB-plex ? 16 Fireplace ? 21 Porch(3-sea.) ? 31 Ext.Ait - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.) ? 33 Ext. Ait - SF
? 04 02-plex ? 10 OB-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or_N ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int improvement ? 38 Demolish Interior ? 44 Siding
? 32 Adddion ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building' ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement `Uemolkion (Entire Bldg) -Give PCA handout to applicant
Valuation Occupancy MCES System
Plan Review 100% or 25%
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Width
REQUII2ED INSPECTIONS
_ Footings(new bldg) FinaUC.O.
_ Footings(deck) FinaUNo C.O.
_ Footings (addition) _ Plumbing
_ Foundation HVAC
_ Drain Tile Other
Roof _ Ice & Wa[er _ Final _ Pool _ Ftgs _ Air/Gas Tests Final
_ Framing _ Siding _ Stucco _ Stone _ Bri ck
_ Fireplace _ R.I. Air Test Final Windows
_ Insulation _ Retaining Wall
Approved By:
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Perrnit & Suroharge
Treatment Plant
License Search
Copies
Other
Total
Building Inspector
Use BLUE or BLACK Ink
I For Office Use I
j Permit
City of Ea
Ea~ l
I Permit Fee: i
3830 Pilot Knob Road I
Eagan MN 55122 j Date Received: j
Phone: (651) 675-5675
Fax: (651) 675-5694 1 Staff:
`
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: ® Site Address: Unit
Name: Phone:./,05 J - Z 7'-5_17
RESIDENT
L ~E
OWNER Address/ City/ Zip: 04,AA-7 E~~d d
Applicant is: Owner -2- Contractor
TYPE OF WORK Description of work:
Construction Cost: *5-a0- e96 / Multi-Family B • ilding: (Yes / No A_J
Company:7D/Af eLty L oWMec,P4?9A Contact: ~12&-I€ S71?A91WAW02
CONTRACTOR Address: _ lO d/ E A41F / City: _ /"PL,-5
State: N• Zip: Phone:
License L+3®.~~ Lead Certificate /04 r~ 3
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
/N'6 LF~3
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. tc ooherstateonecail.org
1. 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_ x
Applicant's Printed Name T Applicant's Signature
Page 1 of 3
Use BLUE or BLACK Ink
r
I For Office Use I
Permit#: City
of Ea Rd~
' jpS, a
I Permit Fee: I
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received: J 3 I
I
Phone: (651) 675-5675 ~ I
Fax: (651) 675-5694 I Staff: ors
I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: rUnit
Name: Phone: 1051..2 ` "'M*4,51
Resident/ ~~75' /VIDJV ZN Iii(/ H ~/y
Owner Address /City /Zip:
Applicant is: Owner X Contractor
Type of Work Description of work: Construction Cost 7J Multi-Family Building: (Yes / No
Company: ~z,p/1d ~ • Contact: h /qtr VJ &4)ree-
Contractor Address: 21 -7 40/10 o~5"&Z_ h city: Blao ~.t/'!s ~,C/
State: zip: Phone:_ rn~r~~yl ~Z
License S` Lead Certificate
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.gopherstateonecail.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 buil ng permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issua ce.
r
x 4.,7 Z IA/ t1AZ46 Wli0-x
p s Printed a App c igna re
Page 1 of 3
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PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA161638
Date Issued:06/05/2020
Permit Category:ePermit
Site Address: 1775 Monterey Lane
Lot:11 Block: 3 Addition: Ridge View Acres
PID:10-64000-03-110
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 -
Edward J Neppl
1775 Monterey Lane
Eagan MN 55122
Haferman Water Conditioning
12142 12th Ave.
Burnsville MN 55337
(952) 894-4040
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA176000
Date Issued:04/26/2022
Permit Category:ePermit
Site Address: 1775 Monterey Lane
Lot:11 Block: 3 Addition: Ridge View Acres
PID:10-64000-03-110
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 -
Edward J & Patricia Neppl
1775 Monterey Ln
Saint Paul MN 55122--114
Genz Ryan Plumbing & Heating
2200 West Highway 13
Burnsville MN 55337
(952) 767-1000
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA177117
Date Issued:06/16/2022
Permit Category:ePermit
Site Address: 1775 Monterey Lane
Lot:11 Block: 3 Addition: Ridge View Acres
PID:10-64000-03-110
Use:
Description:
Sub Type:Air Conditioner
Work Type:Replace
Description:
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507)
210-0754.
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 -
Edward J & Patricia Neppl
1775 Monterey Ln
Saint Paul MN 55122--114
Genz Ryan Plumbing & Heating
2200 West Highway 13
Burnsville MN 55337
(952) 767-1000
Applicant/Permitee: Signature Issued By: Signature