1658 Oakbrooke WayAddress 1658 oaknrooke way Zip 55122`
LAt 1 Blk I SUb Oakbrooke 4th
TEIESE ITEMS WERE ! WERE NOT COMF'LETE AT TfE TIME OF THE FINAL INSPECI'ION.
Date: ? Yes No Inspector: -
Final grade 6" fro sid' g) `
Petmanent steps (garage)
Permaaent steps (main entry)
Permanent driveway
Peimanent gas
Sod/Seeded grass
TraiUcurb damage
Porch
Basement finish
Deck
Please verif}' with the boilder the removal of roof4est caps from the plumbing system and the shut-off of water supply to
the outside lawn faucet before freeze potential exists.
Contact engineering division at 681-4645 befote working in right-of-way or installing underground sprinkler system. ?
White - City Copy Yellow - Resident Copy Pink - Contractor Copy
Siteaddress: \\4?Sv C?\`?roK?? Lot ` BlockA Subd. oa.?. 1o
\,Q P'Vv
On April 15, 2000 the Minnesota Energy Code, Category I Building Requirements for insulation protection, air
tightness, and ventilation, was adopted. As a resutt, the City of Eagan is requiring that the following information be
submitted prior to issuance of a Certificate of Occupancy.
_ This structure: Is constructed to meet minimum requiremenGS of the Mn Energy Code, Chapter 7670
OR
?This structure: will be constructed to meet more restrictive requirements of Chapters 7672 or 7674
APPLIANCE GAS ELEC MANUFACTURER MODEL BTU'S VENTING TYPE
water Heater t ,,,) 140. \o5Z4 V-S
Fumace k,-- pY?ARJ03b1o0 5`? Wu :rcc?-.
Dryer
EXHAUST SYSTEM
LOCATION
TYPE
MODEL
CFM's VENTED
ves No
Kitchen kitchen
8athroom 1
Bathmom 2 ? • V J_ 0rJ ?
Bathroom 3
Bathroom 4
anar
FIREPLACE S
LOCATION
GAS
WOOD
MANUFACTURER
MODEL
BTU'S VENTING
DIHECT nn+ios
? o ?o?OC??' ? ?
MAKE•UP AIR MODEL TYPE CFM's
I hereby @cknowledge that the above information is correct and agree to comply with the Minnesota Energy Code and Ciry of Eagan
Date
Company Name
This form is the responsibility of the General Contractor.
`+ -a--
2000 BUILDINC PERMIT APPLICATION (RESIDENTIAL)
3830 PILOT KN B RD - 55122 651-881-4673
l'I?wCafMrueNmRaaulre menh ?30??°1
5-ab??D
> a reo.roroa we wneY, anownng s% n. a wr. +q. rt. a naoa s copw. w wm
and 9H rooletl araas f20% mmdmum bi covemae atlowerD 1sOt of eneryy cadcWallora fw heuled atldXan
D 2 copks Of Plrnu fshow beam R wintlow Yzes; Pour6d dW. tleggr, ale.) 1 flPa wrveY fa aOaAOr adcbMOm A tlecb
D 1 tef d erwryy ca4aYaMOiri -
D J coples d hea pmsenaMOn plon M lol pkdW a41w 7/1/93
DAiE: 5?? - CoNSTR,CYIoN COSP
DESCRIPTION OF WORIG ??
S7REET ADDRESS: \`Ps f ooXCQ- \? ? V
LOT: ` BLOCK: \ SUBD./P.I.D. i: rovV2_ ?4 1h
PROPERTY
OWNER
CONiRACTOR
ARCHITECi/
ENGINEER
Name: Phone 1:
Laq prfl
Sheet
City
Sfate:
ZiP:
53??3
ComPany?•,.C, ?ec r?, \v\vx ? Phone
(area code)
Sheef Addresx\?SS Mend???e:c,?n\? -1oo uoanse # \`l Ex,. 3• o?
CltyStafe: Lp: 55 \ZJ
Company: Name:
Telephone t: (
Sheet Address: Regkfrailon 11:
Ciry
SMfe:
Lp:
Sewerhvater licensed plumber (H Irmfallira aewerMrater): Phone #: \I ci-11\
t hereby ackrawledye Mwf I have read Ihis applkaNon, dafe Mwt Ihe Ifon k oorre?f. and a e to cromply wHh al opp6cdble Sfate
of Minneaota Stalutea and Cily o} Eaqan Ordinancea.
Sipnolure of Applkanf:
OFFICE USE ONLY
Certificates of Survey Received ?Yes _ No
Tree Preservation Plan Received ,_ Yes No ?Not Required
OFFICE USE ONLY
.
BUILDING PERMIT SUBNPES
O 01 FoundaUon O 07 OSplex 0 13 18-piex O 21 Porch (3-sea.) O 31 Ext. Alt - Multl
A 02 SF DwelGng O 08 06-plex O 17 Garage 0 22 PorcNAddn. (4sea.) O 33 Ext. Alt - SF
O 03 01 of_ plex O 09 07-plex O 18 Oedc O 23 Poreh (screened) p 36 Multl
O 04 02-plex 0 10 OB-plex O 19 Lower Level O 24 Stortn Damage
0 05 03plex O 11 10-piex Plbp Y a_ N C3 25 Miscellaneous
0 06 04-plex O 12 12-plex O 20 Pool O' 30 Aocessory Bidg.
WORK TYPE
? 31 New O 36 Move Bldg. p 43 Reroof
O 32 Addition 0 37 Demolish (Bldg)' O 44 Siding
O 33 Alteration O 38 Demolish (Interior) O 45 Fire Repair
? 34 Repair 0 42 Demolish (Foundation) p 46 Windows/Doors
' Give PCA handout to applicant for demolition permit
GENERAL INFORMATION
SAC Code # of Stories ? sq, ft.
No. of Units Length sq. ft.
No. of Buildings Width .7 / Footprint sq. ft.
Const. (Actual) #V Basement sq. ft. ? Census Code
(Ailowable)
UBC Occu
anc Main level sq. ft.
?
ft
,
?? MC/ES System
?
p
y ? .
sq. t City Water
Zoning sq, ft. Booster Pump
PRV ?
Fire Sprinklered
MISCELLANEOUS INSPECTIONS
0 Stucco/Stone
APPROVALS
Planning Building ! . I Xi Engineering Variance
PermitFee Valuation: ?27D
Suroharge
Plan Review
License
MC/ES SAC
Wate Conn.
Water Meter
Acct. Deposit
S/W Permit /
S/W Surcharge
Treatment PI. .
Park Ded.
Treils Ded.
Other
Copies
7otal: =-f S'-I'--I . I 1
SAC Units
% SAC
.
LOT SURVEY CHECKIIST FOR RESIDENTIAL
BUILDING PERMIT APPLICATION
n
N
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W
?
?
0
O
O g z
? ?
?
?g 0
0
0
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o
o ?
?/
o ?
0
? 0
PROPERTY LEGAL:
DOCUMENT STANDARDS
• Registered Land Surveyor signature and company
• BuildingPermftApplicant
• Legal descripUon
• Address
• North arrow and scale
• House type (rambler, walkout, split wlo, spl"rt entry, lookout, etc.)
• Directional drainage arrows with slope/gradient °k
• Proposed/exMng sewer and water services & invert elevation
• Street name
• Oriveway
• Lot Square Footage
• Lot Coverage
ELEVATIONS
Existin
r ? : Sewer service (or Proposed)
? ? Property comers
?? • Top of curb at ihe driveway
? ? • Elevationa of any existing adjacent homes
??? ? Adequate footlng depth of strucWres due to adjacent utility trenches
Prooosed
IV/ ? ? • Garage floor
? ? • First floor
q ? ? • Lowest exposed elevation (walkouWvindow)
? ? ? • Property corners
//o ? • Frorrt and rear oi home at the foundation
? PONDING AREA (it aodicaWe)
?
? .
Easemeni line
? m? ? • NWL
? ?? • HWL
? ?? • Pond # designation
? r,? ? • Emergency OverAow Elevation
DIMENSIONS
a0 Lot lineslBearings & dimensions
m' o?
? • RightoT-way and strcet width (to back of curb)
'
? ? , porches, etc.
• Proposed home dimensions induding any praposed decks, overhangs greater than 2
/ (i.e. all structures requiring permanent footings)
df/ ?? • Show all easements of record and any Cily utili0es wdhin thoae easements
ra' ?.? • Setbacks of proposed struclure and sideyard setback of adjacent epsling shucturea
??? • Retaining wall requ
7;zrz
/?
.
Reviewed:
iA
¢
DATE OF SURVEY:
LATEST REVISION:
March 1999
GfUIGIBIOGPRhR.FM
`.J
JOB INITIATION ORDER
? Pulte Homes of
Minnesota Corporation Vf?l CONTRACTORISUPPLIER:
1355 Mendota Heights Road, Suite 300
Mendota Heights, MN 55120-1712
Phane: (651) 452-5200 Fax: (651) 452-5727
JOB NO. k..e
CONMUNITY:
BUILOtNG AD
NpDEL NUNBER:
ADOffION:
00
Lp7 ? BLOCK I UNIT _.? 1
-?t- T /
BUYER'S NAME: OATE OF ORDER:
CURRENT
MONE PHONE: BUSMESS PHONE
SALES flEPRESENTATIVE?
STATE:_
BUSPiES3 PtiONE:
s?t?Ia!?i/99''?v
Y?F?i ?S'????QV?.11?51[?
0000 ?. ??a????'J,Po.,h•"w?.??& ? f?i.A?i"?i??4?rk9,??,'G+?f?MQ?.vI,'1?????'. .?..R., .
BASEPRICE
pry /?
-- LOTPREMIUM C)
I. D3 ELEVATION # ( q?
1 , C
I 'PLOIct
i 3 5
- f- a w
r? ? ... .. Ci ,J ? ..?..
TOTAL ater LTE
Builder
Builder's License #0007371
? -L LEGAI.
APPROVED BY BUYER (S): ?c-- ?
APPROVED BY SALES: ?
RELEASED TO START CONST.: EaunL Housuuc
OPPORTUNITY -
This constitutes a corrtract between the Seller and the Purchaser(s) forthe aWve items.
Cities Digital Quality Control
The following image represents the best
available image from the original page.
Every effort was made to capture the content
from the original page.
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ROOP/CEILiNG
TOTAL? EXPOS'cD NAI,k.AREA- CALCULATIQN-
?3
l'. . i 1' '.3t1 s? •-:.? .? o ? .. ? ' - w a ? r ?? y?
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` area;abvve floor` ...... ZZ?j _ sq ft
%
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a) Total`wa11 window area:
.??1?;
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41
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TOTAL QXAqS'U 104F/CEilitl4 cnLcuLariOW ;
.?
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rooP/eei Ylntl area...... f c
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17
? k?
. . - Surveyor's Certificate
SURVEY FOR :PULTE
DESCRIBED AS ; Lot 1, Block 1, OAKBROOKE 4TH ADDITION, City of Eogan, Doko[o County, Minnsoto and
reserving easements of record.
?
1658
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(RDAD OT COS l1CTED
? ^9?' a^A-=ntAxn DRntNAGr
n L_38 g ro STRBET ???
- EAST 33. R=18•
? _j ,2 33„
J
?d 93b.
"a 3• q35' , 37" 4. 0
r ? --------i 93bN 20.67
oa 8
i. '
L. 3
N \ ?
Goro9°
og3'1Z
, ,93 7 o g ?
i 00 Q1 l!1 ? SO ?`
? i Proposed Hom N ?
i TOB = 919.5 i 4.62
ProGOSed
? Ramblar W W \ ? ?1
Slob on
Grode m \ \ ??
10.50 00
i r- -
00 CP
'p PMth O W
`--------- ? O o ?? CA
? 24.50 3,2 2D 5 q3 C)
00 35- 931.
0 93
9353 S 19 NJ 44.
9'42 3 'W ?ZLT
a 25. o FCNet=
0 0
?I Cli CB? J '
(fi O 42Z• O (-n
m r*i
7 8942 35 E N89'42'35"E 50.46
L0T SQ. F00TAGE = 3 608 HSE. SQ. FOOTAGE = 2>367 ? ?E 0 ED ?
LOT COVERAGE = 667
?
Dat£
Plon p 1?95? ? '.?CiAANEIlTGI1?TFLEiIPdt?rDEPT, N
PROPOSED ELEVATIONS
BENCHMARK,
Top of foundation = 938.0
Goroge Floor = 93(o.9
Bosement Floor = Nin
Aprox. Sewer Service = 924,-It
Proposed Elev, _? MIN. SETBACK REQUIREMENTS
Existing Elev. _
Droinage Directions = Front -25 House 5ide -
Denotes Offset Stake = • scnLE: i inon - 30 reet Rear - Garoge Side-
JOB N0:
H?D???? I HEREBY CERTIFY THFT THI$ IS A TRUE AND CORRECT REPRESEN7ATION OOR-212
Of THE BOUNOARIES OF THE ABOVE DESCRIBED PROPERTY AS SURVEYED
BY ME OR UNDER MY OIRECT SUPERVISION AND DOES NOT PURPORT TO BOOK: PACE:
PLANN/NG 6NC/N6SR/NC SURV6Y/NC SHOW IMPROVEMENiS OR ENCROACNMENTS, EXCEPT AS?pOwN.
)
2005 Pin Ook Drive
Eogon, MN 55122 DATE CAD fILE:
Phone: (651) 405-6600 F'RE . LINOCREN, LAND VEYOR
Fox: (651) 405-6606 NNE TA LICENSE NUMBER 14576 OAKBROOKE
RECEIVED MAY 2 3 2000
CITY USE OIVLY
LOT ? BL / PERMIT#: I 13 lo ?
SUBD. y'00Vj_e LI?- RECE[PT
RECEIPT DAi'E: -)0- O 0
2000 MECHANICAL PERMIT (RESIDENTIAL)
Date: (.P - I 5" l.lJ
Complete this section onlv if you are installing HVAC in a single family dwelling, townhome or condo under
construction and not owner/occuoied.
• HVAC: 0-100 M B T U
ADDITIONAL 50 M BTU
• Gas outlets (minimum of one required @$3.00 ea.)
State Surchazge
Total
$ 30.00
6.00
S-00
.50
$ 39, 6?)
Complete this section onJv if you are remodeline, addine to, or re airin an existing single-family dwelling,
townhome, or condo. Please indicate if it is a new item, alteration, or repair.
New Alteration
' Fumace
Air exchanger
Air conditioning
Other
Fee $ 30.00
State Surchazge .50
Total $ 30.50
Reminder: Call for inspections
SI'fE ADDRESS:
OWNERNAME: ?? Ilk- 9ZJYtt'LJ V PHONE#: COc' - L/Sa
O
INSTALLER NAME: I ?I I C'. PHONE #: ( 97a DE) 4qy?5
STREETADDRESS: laLa7 RhO['?Q •?S? ? e S (ARFACODE)
c?TY:
CITY OF EAG7aN
3830 PIIAT IQ70H RD
EAGAN bAI 55122
651-681-4675
_ Repair _ Other
STATE: M /j ZIP: 53-7
SIG ATURE OF P ITTEE
L BL
SUBD.
APPROVED BY:
INSPECTOR
PERMIT #:
RECEIPT#:
RECEIPT DATE:
2000 MECEiANICAL PERMIT (CODIIdLRCIAL)
CITY OF EAGAN
3830 PILOT RNOB RD
EAGAN, t+ai 55122
651-681-4675
Please complete for: ail commerciaVindustrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
DATE:
WORK TYPE: New consWCtion Install U.G. Tank
_ Interior Improvemen[ _ Remove U.G. Tank
_ Processed Piping
When installing/removing underground tank, ca!! 651-681-4675 jor inspeclion by fire marshal and
plumbing inspector.
Description of work:
Fees: 1% of contract price OR $30.00 minimum fee, whichever is greater.
Underground tank removaVinstallation = minimum fee
Contract price: $ x I%= $ (Base Fee)
State surchazge calwlate at $.50 for each $1,000 Base Fee
TOTAL $
SITE ADDRESS:
OWNER NAME: PHONE #:
(AREA CODE)
TENANT NAME (IMPROVEMENTS ONLY):
WAS THERE A PREVIOUS TENANT IN TH[S SPACE? Y N. NAME:
INSTALLER:
ADDRESS:
CITY:
PHONE #: -
(AREA CODE)
STATE: ZIP:
CITY USE ONLY
.
SIGNATURE OF PERMITTEE
L BL CITY USE ONLY
sUBO.
RECEIPT #: , 3 0 7?V
RECEIPT DATE: S- DP 'GD
PERMIT# V (0
2000 PLUMBING PERMIT (RESIDENTIAI,) ??
CITY OF &AGAN
3830 PILOT KNOS RD
EAGAN, 347 55122
651-681-4675
Please complete for: ? single family dwellings
D townhomes and condos when pertnits are required for each unit
? backflow preventer for underground sprinkler system
FIXTtIRES EACH # TOTAL
Akerations to existing dwelling - minimum fee
Describe: $ 30.00
Bath tub $ 3.00 x = $
Floordrain 3.00 x = $
Gas piping outlet ' minimum -1 3.00 x = $ -
Hot tub/spa 3.00 x = $
Kitchen sink 3.00 x = $ -
Laundry tra 3.00 x = $
Lavato 3.00 x = $ -
Septic System newireturbisned • requires MPC lic. 75.00 x = $
Se tic System abandonment 30.00 x = $
RPZ new installationlrepaidrebuild 30.00 X = $
Rough opening 1.50 x = $
Shower 3.00 x = $
Underground s rinkler ifdwelling is underconstruction 3.00 x = $
Under round sprinkler if existlng dwelling 30.00 x = $
Water closet 3.00 x = $ -
Water heater 3.00 x = $
Water softener if dwelling under eonsvuctlon 5.00 x = $
Water softener if exlsting dwelling 30.00 x = $
Water tumaround 30.00 x $
State Surcharge .50 -> -> -> S .50
TOtal -> -> -> --> S
Reminder: Call for inspections of alterations, i.e. water heaters, water softeners, etc.
-
- - - •----- ---- -- --- ----- - -- -- • --- ------ ------------•--•-------------•---------------- -------------•------- ---- ----•--
- s. -
1 hereby adcnowledge that I have read ttiis application, state that the intortnation is correG, and agree to compty with ali applicable Ciry of - Eagan - ordinance
It is the applicanYs respansibility to notify the property owner that the City of Eagan assumes no liability for any damages wused Ey the City during ks
nortnal operational end mainter.ance adivfties to the facilities constrLiclad under this pertn@ within Ciry propertylright-of-way/easement.
SITE ADDRESS:
OWNER NAME: :
INSTALLER NAME:
TELEPHONE #:
(AREA CODE)
TELEPHONE #: qc--g "'
(AREA CODE)
STREETAZ=24 RESS: Olrl?) ( dA.(C?jll?(? -
CITY: ( STATE: 1214 ZIP:
SIGNATURE OF PERMITTEE
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PERMIT
City of Eagan Permit Type:Building
Permit Number:EA125376
Date Issued:07/22/2014
Permit Category:ePermit
Site Address: 1658 Oakbrooke Way
Lot:1 Block: 0 Addition: Oakbrooke 4th
PID:10-53763-01-010
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 -
Rebecca M Smith
1658 Oakbrooke Way
Eagan MN 55122
Property Claim Solutions Llc
2005 Pin Oak Dr
Eagan MN 55122
(651) 994-2028
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA128007
Date Issued:10/22/2014
Permit Category:ePermit
Site Address: 1658 Oakbrooke Way
Lot:1 Block: 0 Addition: Oakbrooke 4th
PID:10-53763-01-010
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
Carbon monoxide detectors are required by law in ALL single family homes .
Lisa Nyberg
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 -
Rebecca M Smith
1658 Oakbrooke Way
Eagan MN 55122
Property Claim Solutions Llc
2005 Pin Oak Dr
Eagan MN 55122
(651) 994-2028
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA136953
Date Issued:06/08/2016
Permit Category:ePermit
Site Address: 1658 Oakbrooke Way
Lot:1 Block: 0 Addition: Oakbrooke 4th
PID:10-53763-01-010
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 500.00
Fee Summary:BL - Base Fee $500 $40.00 0801.4085
Surcharge - Based on Valuation $500 $0.50 9001.2195
$40.50 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 -
Rebecca M Smith
1658 Oakbrooke Way
Eagan MN 55122
(651) 402-5074
Crew2 Inc
2650 Minnehaha Ave
Suite 100
Minneapolis MN 55406
(612) 276-1680
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA148959
Date Issued:04/30/2018
Permit Category:ePermit
Site Address: 1658 Oakbrooke Way
Lot:1 Block: 0 Addition: Oakbrooke 4th
PID:10-53763-01-010
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
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 -
Rebecca M Smith
1658 Oakbrooke Way
Eagan MN 55122
Renewal Andersen
1920 County Road C West
Roseville MN 55113
(651) 264-4777
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA157683
Date Issued:09/04/2019
Permit Category:ePermit
Site Address: 1658 Oakbrooke Way
Lot:1 Block: 0 Addition: Oakbrooke 4th
PID:10-53763-01-010
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 5,000.00
Fee Summary:BL - Base Fee $5K $118.00 0801.4085
Surcharge - Based on Valuation $5K $2.50 9001.2195
$120.50 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 -
Rebecca M Smith
1658 Oakbrooke Way
Eagan MN 55122
Renewal Andersen
1920 County Road C West
Roseville MN 55113
(651) 264-4777
Applicant/Permitee: Signature Issued By: Signature