1566 Oakbrooke Terfi-
--,'14 `i -i 9 a (JP -
??SllbENTIAL rV10
BUILDINC PERMIT APPLICATION
CITY OF EAGAN Q? -H(, loC) C?? -5-`?
3830 PILOT KNOB RD - 55122
651-681-4675 ?'-
NewConstmctionReaWrements RemodeUReoairReauirements ? l __?) I "
• 3 registered site surveys showing sq ft of IoC sq. ft. of house; and all roofed areas • 2 copies o( plan
21 (ZO% mazimum bt coverage allowed) . 1 set af Energy Cakulations for heated a s ^I
• 2 mpies of plan showing beam & window s¢es; poured found design, etc.) 1 srte survey for exterior addilbiu & decks $- C( _ V )
• 1 set ot Energy Cakulations vv 1 (
• 3 copies of Tree Preservation Plan if lot platted after 7!1l93
• Rim Joist Detail Optlons selection sheet (bldgs wilh 3 or less unifs) I`f I I O
1
DATE rll
)A)
JOB SITE AD
TION (EXCLUDING LAND)
IF MULTI-FAMILY BUILDING, HOW MANY UNITS?
PROPERTY OWNER y?t{, /hmt s p??)U CA?JU
TYPE OF WORK /,cc6ldGwalti ? FIREPLACE(S)/ _0 !!?1' _2 _3
APPLICANT -S+M,L AS PHONE #
ADDRESS gIs .110M WLbt PArPK)/Y?v S?1fC HO ZIPCODE
PAGER # CELL PHONE #Q36q-1)a 1 FAX #6SI'49it `'t*4ka7
NE1V RESIDENTIAL BUILDING ONLY - FILL OUT
Energy Code Category
(check one)
?
MINNESOTA RULES 7670 CATEGORY 1
- Residen6al Ventilation Category 1 Worksheet Su
- Energy Envelope Calculations Submitted
MINNESOTA RULES 7672
- New Energy Code Worksheet Submitted
Plumbing Contractor. IlA???? fth??l&' Phone #:
Plumbing System Includes: Water Softener _ Lawn Sprinkler
F/1_ Water Heater L No. of R.I. Baths
ELY
IU
Fee: $90.00
3 No. of Baths Gja`,Z
t? - ??iz- 2?17
Mechanical Contractor: ?1/? c1J1 ??2 rlkvd'9?n/f Phone #ilt-0
1'Icchanical System Includes: Air Conditioning Fee: $70.00
AW Heat Recovery Systcm
Sewer/Water Contractor: /9L'/1'D 64<'41 sCM<-P..S Phone # 763` ?'?Qt- °m3s'
All above information must be submitted prior to processing of applicatlon.
I hereby acknowledge that I have read this appiication, state that the information is correct, and agree to comply with
all applicable State of Minnesota Statutes and City ot Eagan Ordinances.
Si9nature of Appllcant "'(/47?I7"" kl?t
Certificates of Survey Received ? Tree Preservation Plan Received _ Not Required ?
Updated 1/Ot
OFFICE USE ONLY
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool
y 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.)
? 03 01 of _ piex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.)
? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screened)
? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
W 31 New
? 32 Addition
? 33 Alteration
? 34 Replacement
? 30 Accessory Bldg
? 31 Ext. Alt - Multi
? 33 Ext. Alt - SF
? 36 Multi
? 35 Int improvement ? 38 Demolish (Interior) ? 44 Siding
O 36 Move Bldg. ? 42 Demolish (Foundation) O 45 Fire Repair
? 37 Demolish (Bldg)• ? 43 Reroof ? 46 Windows/Doors
'Demolition (Entire Bldg only) - Give PCA handout to applicant
Valuation U?
Occupancy
Census Code /, v l Zoning
SAC Units Stories
Nbr. of Units ? Sq. Ft.
Nbr. of Bldgs ? Length
Type of Const ? Width
? Footings (new bldg)
_ Fooungs(deck)
Footings(addirion)
?p Foundation
Drain Tile
7 Roof
Ice & Water Final
_
_
Framing
Fireplace Y( R.I. V Au Test
I
l
i
7 I Final
nsu
at
on
R- 3 MC/ES System
p --J) City Water
a? Booster Pump
[?LE PRV ?;?
• -
S2 i
Fire Sprinklered
Z/ 6y
REQUIRED INSPECTIONS
?j FinaUC.O.
FinaUNo C.O.
_ Plumbing
_ HVAC
Approved By. (ZZ , Building Inspector
3ase Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit 8 Surcharge
7reatment Plant
Plumbing Permit
:Mechanical Permit
License Search
Copies
Jther
Total
_ Other
_ Pool Ftgs Air/Gas Tests _ Final
_ Siding Stucco Stone
_ Windows (new/replacement)
? dCa,LGsz lL f3ts'4?a?
4YI/g,z,v LE//?L
,2
1 v
yP/ x` 7, rs6
?ta ? ? ?)-`?
Address _1566 Oakbrooke rerrace Zip 5512 2
LAt 11 BIk 4 Sub Oakbrooke Sth
THESE ITEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECITON.
, t
Date: ? Yes No Inspector:
Final grade (6" from siding)
Permanent steps (garage)
Permanent steps (main entry)
Permanent driveway
Permanent gas
Sod/Seeded grass
TraiUcurb damage
Porch
Basement finish
Deck
Please verify with the builder the removal of roofftest caps from the plumbing system and the shuFOff of water supply to
the outside lawn faucet before freeze potential exists.
Contact engineering division at 681-4645 before working in rightof-way or installing underground sprinkler system. ?
While - City Copy Yellow - Resident Copy Pink - Contractor Copy
-50 % 0 ?
AULTI-FAMILY BLDG _ Y _ N
New Conelruetlon Reaulrementa
• 3 registeretl sde surveys shpwing aq. fl. of bt, sq. fl. of frouse; and II roofetl areaS
(20% maximum bl coverage allowed)
• 2 coples of plan showing beem 8 window sizes; poured tound design, etc.)
• lsetofEnergyCetulatbns
• 3 coples of 7ree Preservetan Plan H bt platted atter 711/93
• Rim Joist Detell Optlons selectbn sheat (hltlgs wilh 8 or less unAS)
DATE EO O02
SITE ADC
TYPE OF
APPLICANT
FIREPLACE(S) _ 0 _ 1 _ 2
- _ ?na4z2 -7?-
/ ?.
STREETADDRESS y1W A4°c,J Y04t /11ve- CITY 4AG?/,/ STATEIwNLP5r>-Z&--1
TELEPHONE i CELL PHONE # 6101-615e-?,x'20 FAX #
/
PROPERNOWNER -IONe??e -/ohNSoN TELEPHONE#
-----------------° ------° °---------------°----°---------------------°---------------° °-
COMPLETE THIS SECTION FOR %NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1 MINNESOTA RULES 7672
(4 submission type) • Residential Ventilafion Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Envelopa Calculafions Submitted
Plumbing Contracfor:
Piumbing system includes:
Mechanlcal Contracfor:
Mechanical system includes:
Sewer/Water Confracfor:
Ya?
VALUATION
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OP EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
? Water Softener _
_ Water Heater _
No. of Baths
Air Conditioning
Heat Recovery System
RemodeVReoalr Heaulremems
. 2 copies o1 plan
. 1 set of Energy Calwlatlons for healed additions
. 1 stte survey tOr extefbr adtlflbns & tlBCkB
• tndicate if home serred by septk system tor addWn
Phone #
Lawn Sprinkler
No. of R.I. Baths
Fee: $90.00
MAY 2 0 ZODI
#
$70.00
--------°°--------------------------------------------------------°----°----°-------°-°------°-°°---------°-----
I hereby acknowledge that I have read this application, state that the Information is correct, and agree to comply
with all applicable State of Minnesota Statutes and Clty of Eagan Ordin ces.
Signaiure at Applicant ,
OFFICE USE ONLY
Certificates of Survey ReCeived _ Tree Preservation Plan Received _ Not Required _
Uptlated 4/02
OFFICE USE ONLY
? 01 Foundation ? 07
05-plex
? 13 16-plex
? 20 Pool ? ' .,
30 Accesso'ry Bldg
? 02 SF Dwelling ? 08 06plex ? 16 Fireplece O 21 Porch (3sea.) 0 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4sea.) O 33 Ext. AIL - SF
? 04 02-plex ? 10 08-plex ?% 18 Deck ? 23 Porch (screened) ? 36 Multi
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
? 31 New 0 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
32 Addition O 38 Move Bldg. ? 42 Demolish (FOUndation) ? 45 Fire Repair
O 33 Afteration ? 37 Demolish (Bldg)` ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement *Demolition (EMire Blqg only) - Give PCA handout to applicant
Valuation G?' fiJ Occupancy 1L WIZ MG/ES System
Census Code Zaning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bidgs Length Fire Sprinklered
Type of Const WJ Width
REQUIRED INSPECTIONS
Footings (new bldg) FinaVC.O.
Footings (deck)
Footings (addition)
Foundation
Drain Tile
Roof Ice & Water Final
_ Framing
_ Fireplace _ R.I. _ Air Test _ Final
Insulation
y FinaUNo C.O.
T? Plumbing
HVAC
Other
_ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Siding Stucco Stone
_ Windows (new/replacement)
_ Retaining Wall
Approved By / L- . Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
Cfty SAC
W ater Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
?2/ ?? 4-,20_
Copies
Other
Total
Surveyor's Certzficate
SURVEY FOR :PULTE HOMES
DESCRIBED AS :Lot 11. 81ock 4, OAKBROOKE STH ADDIION, Clty of Eagcn, Minnesoto and reaerving
easements of record.
AUG 0 8 REC'4
A
?
?.
.h
It
ED
z3y
F..P',GTIdFr,,1:ING DEFT.
?
??...0qN v
K • .a?'?
# ,so52
PROPOSED ELEVATIONS-_
Top of Foundation = 434.s"
?
,.
;.
Garage Floor =939,1
Basement Fioor =930.5
Aprox. Sewer Service =927.5?
Proposed Elev.
Existing Elev. _
Drainage Directions =
Denotes Offset Stake = • scu.e: i inon - 30 feel
S/ L'r
FgNCe
BENCHMfiRK, 0?tol Pnt,1;q0ca
Eleo = 950.01
MIN. SETBACK REQUIREMENTS
Front - House Side -
Rear - Garoge Side-
JOB N0:
HEDLUND I HEREBY CERTIFY 7HAT THIS IS A TRUE AND CORRECT REPRESENTA110N 01R-301
OF THE BOUNDARIES OF THE ABOVE DESCRIBED PROPERTY AS SURVEI£D
BY ME OR UNOER MY DIRECT SUPERNSION AND DOES NOT PURPORT TO BOOK: PAGE:
PLANN/NC 6NGINBBR/NC SURVdY/NC SHOW IMPROVEMENTS OR EN OAGiMENTS, E%CEPT AS MOWN.
2005 Pln Ook Drive 1p /1
Eagan, MN 55122 DATE ??LfL/y_1 CAD FlLE:
Phone: (651) 405-6600 C LINOC N, LAND 5 RVEYOR
fox: (651) 405-6606 Nfa uCEnSE NUMB 4376 Oakbrooke 5
L 0 T SC1. F00 TA GE = 8,428
HSE SQ. F00 TA GE = 91 79 7
L 0 T C01/ERAGE = 219'
PERMIT # d"-' q (
RECEIPT DATE:
2002 MIDENnAL PLUMB1NEi PE{iblIT A#'PLICA'fION
crrY oe EAsArT
5880 PILOT KPOS RD
grqHAN, MP 55128
651-6$1-4675
Please complete for:
SITE ADDRESS:
single family dwellings, townhomes and condos when permits are required for each unit,
backflow preventer for irrigation system
OWNER NAME' ? orrri?/G `?1+3e'y? _ TEIEPHONE #1:!f5
(A EA CODE)
INSTALLER NAME:
E#: 7r5 3W
(AREA CODE)
STREETADDRESS ^_Q op,
STATE:f-c?•
cirv:
SEPTIC SYSTEM, new/refurbished (requires two sets of plans and MPC license) g 100.00
includes $40.00 County fee
Note: Additional consultant fees may apply
. MODIFICATIONIALTERATION TO EXISTING DWELLING UNIT, INCLUDING:
_ Adding fictures to lower levels or room additions, exGuding water softeners and water heaters. $ 50.00
_ Abandonment of septic system.
Water turnaround - existing dwelling unit (+ 5/8" meter if needed -$118)
Other:
_ RPZ: new installation/repair/rebuild $ 30.00
_ lawn irrigation system
ReplacemenUadditional: A water softener _ water heater $ 15.00
/!
F 2$ 50
StateSurcharg
e
Total _?
I hereby acknowledge that I have read this applicalion, state thatthe information is cortect, ee to wmplywith all
istheapplicanPsresponsibility tonotitythepropertyownerthattheCityofEaganassu sn ia6ilityforany?e
operational and meintenance activdies to the ?cilities wnstruded under this pe ' v+thi ity pwpertYlrig of-way?/?
of Eagan ordinances. It
a City during Rs normal
OF PERMITTEE 1102
Site address ? ? U ?)A ft ? Lot /I Block T Subd. "r?????x?sty)
On April 15, 2000 the Minnesota Energy Code, Category I Building Requirements for insulation protection,.air
tightness, and ventilation, was adopted. As a result, the City of Eagan is requiring that the following information be
submitted prior to issuance of a Certificate of Occupancy.
This sWcture: is constructed to meet minimum requirements of the Mn Energy Code, Chapter 7670
? OR
This sVucture: will be constructed to meet more restrictive requirements of Chapters 7672 or 7674
APPLIANCE GAS ELEC MANUFACTURER MODEL BTU'S VENTING TYPE
WaterHeater !tfl ?-So,
Fumace enhJX G'a ?j 70 p3j A C
Dryer
EXHAUST SYSTEM
LOCATION
TYPE
MODEL
CFM's VENTED
rES No
Kitchen kitchen
Bathroom t ?? se')?j)
Bathroom 2 h 3- o
Bathroom 3
Bathroom 4
Other
FIREPLACE S
LOCATION
GAS
WOOD
MANUFACTURER
MOD
E
L
BTU'S VENTING
DIRE6T ATMOS
y
?
I hereby acknowiedge that the above information is correct and agree to comply with the Minnesota Energy Code and City of Eagan
requirements.
ej4lnl&?&
ss?J
CompanyName
Date
This form is the responsibility of the General Contractor.
MRR-16-2020 10!26
:7ch9ck COM?LIANCn RE20RT
Minneaota Snergy Cods
t+IIdcheck BofCware version 3.0
COL'NPY; Dakota
STA.;B: Minneeota
20NE; 2
Cp;.IBTRUCTSON TYPE: Sl,ngia Family
DATE: 3-16-2000
DA'PE OF PLANS: 3/16/00
TITLE : FALAIRR W/0 EL. #2
COMPLIANCL: PASSEb
Requirefl UA = 508
Your Hcme = 407
19.9k Hetter Than Code
P. 02.'02
Perm t #
C ecke y raCe
axea or Cavity Cont. Gla2ing/DOar
Perimeter k-V&lue R-Va::.,ue U-Vaiue
------------------------------------ -------------------------------
CRI"INGS CEIS,INCi9 1444 44.0 0.0
WALLS: Woqd Frame, 16° p,C. 2327 19.0 2.6
WALL3: Wood Frame, 161r O.C. 283 10.0 e.0
BSMT; Conc. 9.0' ht/8.3' bg/9.0' ineul 402 11.0 0.0
GLAZIIVG: Windows or poora, Above Grade 485 0.356 1
DO0RS 38 0.350
FZ+OOR.S: C?ver Unconditioned space 352 38.0 0,0
FNAC EQUI$MENT; Furnace, 92.0 AFI7E
' ------------ ` ----------------- ------- ^-°--------,-
COMPLIANCE STATEMEN';; The proposed buflding desigr_ deacribad here.is - J
conaistant with the buildinc plans, gpeoificatione, and ethex calculations
submitted with the permit appSica_ioa. The propo9ed building has been
desigried to me _ J
e Mipa"ota Enercry Code.
?
BuildeY/D2e
Dat e?-a/_
. K ?_g.1EPi
70TpL P.02
LOT SURVEY CHECKLIST FOR RESIDENTIAI
. . BUILDING PERMfT APPLICATION
? PROPERTYLEGAL:
? DATE OF SURVEY: '7-
?
? LATEST REVISION:
r
?
a
p Z Q DOCUMENT STANDARDS
? ? • Registered Land Surveyor signature and company
/? ? • Build'mg PertnitAppCxznt
m'/ ? ? . Legal description
C?' ?
? ? • Address
N
?/?
r o ?
? •
• orth arrow and scale
H
t
bl
Cd
/
lR
k
t
t
b
k
t
t
? ouse
ype (ram
er, wa
ou
, sp
w
o, sp
en
ry,
o
ou
, e
c.)
0/? ? • Directional drainage arrows with sbpelgradient %
M/?? ? • Proposed/exisdng sewer and water services 8 invert elevation
p/? o • Street name
d ?
@/ ? • Drnreway
?
- ? • Lot Square Footage
?
0 ? • LotCoverage
ELEVATIONS
/ Exastina
H ? ? • Sewer service (or Proposed)
t?/? ? • Propertycomers
L9' ?? • Top of curb at the driveway and properiy Ane extensians
? u/o • Elevations of any epsting adjacent homes
? C[l/,[l • Adequate footing depth of structures due to adjacent u?lihr trenches
? ?? ? • W aterways (pond, stream, etc.)
Prooosed
/
¢'/ 0 ? • Garage fbor
[?' ?
g/ ? ? . First fbor
L
f/
i
d
o .
oweffi exposed elevation (waqcou
w
n
ow)
[A?/0 ? • Property comers
r9' ? ? • Front and rear of home at ttie foundatbn
PONDING AREA ('rfaooficeble)
? ta'J? • Easement0ne
? Q?/ 0 • NWL
? [? ? . HWL
? /0 • Pond # designatbn
? ?? ? • Emeigency Overibw Elevation
/ DIMENSIONS
d/ 0 ? • Lot tineslBeartngs & dhnensbns
07"/ ?? • Rightof-way and sVeet wWth (to back of curb)
C? ?? . Proposed home d'mensbns including any proposed dedcs, overhangs greater fhan 2', porches, etc.
/ (i.e. aa structures ?eyuiring pertnanent footlngs)
@?? • Show all easements of record and any City utllitles wifhin fhose easements
[Y/ ? 0 • Setbacks of proposed sVUCture and sideyard setbadc of adjacent exisdng atruclures
C9 ?? • Retsining wall requhemenb, If any
Reviewed:
Surveyor's Certificate
SURVEY FOR :PULTE HOMES
DESCRIBED AS :Loc ,,, Block 4, OAKBROOKE STH ADDIION, City of Eagan, Minnesota and reserving
easements of record.
AU G 0 8 RM
IT"
;k
? ?.
R???
?v
?:.?,?.°, •:?_?.i? ;? P,?t;?*?F;ra1Ir7GDE?"I: ,
Q??9
g ,8052
PROPOSED ELEVATIONS
Top of Foundation = 439•5
Garage Floor =939,1
Basement Floor =930.5
Aprox. Sewer Service =927..5*_
Proposed Elev. _ C=)
Existing Elev. _
Drainage Directions =
Denotes Offset Stake = •
HEDLUND
PLANNING dNG1NE6R/NG SURV6YlNG
2005 PIn Oak Drive
Eagan, MN 55122
Phone: (651) 405-6600
Fax: (651) 405-6606
sIL?
fE,pGt
BENCHMARK, ??i PAt #9co8
Eleo = qSD.°1
MIN. SETBACK REQUIREMENTS
Front - House Side -
scue: i Inch = SO feet Rear - Gorage Side-
JOB N0:
I HEREBY CERTIFY THA7 THIS IS A TRUE AND CORRECT REPRESENTATION
OF iHE 80UNDARIES OF TME ABOVE DESCRIBED PROPER7Y AS SURVEYfC)
BY ME OR UNDER MY DIRECT SUPERVISION ANO DOES NOT PURPORT TO
SHOW IMPROVEMENTS OR ENSQOACHMENTS, EXCEPT AS?SHOKN.
DATE -7_/L(L/Y-1
LICENSE NUMBE?Y14376
01 R-301
Oakbrooke 5
L 0 T SQ. FOO TA GE = 8,428
HSE SQ. FOOTAGE = 1, 797
L O T CO l/ERA GE = 21 q
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA108037
Date Issued:11/13/2012
Permit Category:ePermit
Site Address: 1566 Oakbrooke Ter
Lot:11 Block: 4 Addition: Oakbrooke 5th
PID:10-53764-04-110
Use:
Description:
Sub Type:e-Reroof
Work Type:Reroof
Description:House
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.
Carbon monoxide detectors are required by law in ALL single family homes .
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 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 -
Pulte Homes of Mn Corp
1355 Mendota Hts Rd Ste. 300
Mendota Hts MN 55120
Haug Contracting Group dba New Line Roofing
3141 Fernbrook Lane N
Plymouth MN 55447
(612) 251-1152
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA130866
Date Issued:05/19/2015
Permit Category:ePermit
Site Address: 1566 Oakbrooke Ter
Lot:11 Block: 4 Addition: Oakbrooke 5th
PID:10-53764-04-110
Use:
Description:
Sub Type:Siding
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please leave printed pictures of house wrap on site for the final inspection.
When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to
ensure maximum ventilation to attic. Call for final inspection after installation.
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 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 -
Pulte Homes Of Mn Corp
1355 Mendota Hts Rd Ste. 300
Mendota Hts MN 55120
Red Stone Builders LLC
4084 Oakbrooke Alcove
Eagan MN 55122
(612) 236-8888
Applicant/Permitee: Signature Issued By: Signature