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4841 Sky View Ct CITY OF EAGAN Remarks /G a~ 9 Addition~//t Cafar~ ~:icl Ar~~itinn Lot ~ RIk ~ Parcel ~QT~~.~~~Q Owner- _ Street 4841 Skyview Court 5tate Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. ~ , J STREET RESTOR. _.~.~~4 ~ ~ d_ f`. GRADING SAN SEW TRUNK 5EWER LATERAL WATERMAIN WATER LATERAL WATER AREA STORM SEW TRK STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. BUILDING PER. 5AC PARK INSPECTION RECURD I Control No. , CITY OF EAGAN PERMIT TYPE: ~ t e~.~ ar~ 3830 Pilot Knob Road Pe~mit Number. M Eagan, Minnesota 55123 Date Issued: i~1 ! i s/!~ 2 (612) 681-4675 SITE AQDRESS: ~.QT x 2 oc«~. , i APPLICANT: ~~l~1 .KY V1EW CT F,A"~HG`N ~O D !1 ~?~1FAR I ?hlll (812 ) 9~A--?~89 PERl~~T ~S,~UB'~YPE: TYPE OF WORK: A~ ~ ~.:r~n~xc~a o~~c~ir~ Y~~t~ cowvtp~t scwt~EN Po~ . . fHAMlNtd INtiUCAI'tON F1iMA1 ltl~i4l1htk5s p~r,~tpf * 5E1~aRATE Pf.RMIT Rl~flUIREU t~'UK EtE'CTRICAI X . - y- ~i'~ . ~..t. . . _,F. 3 . . {{`{..~~t - l. - F .if`S- . . i ._1 . t-as ~ ']~~~y=~r ! .i _ Tif~"' 3.~ .2' i ~ i F~ TT ~~~v~ ^ OT~- G rtt~l`- _ _ 4 . o 1 ~ r-y ''"'i"' . : -.1 ~..~-`a. x ~ ~1~,t~,-;,_ - , ~ ~~Y 1 .~s . r-u ;.~-e ' F~ a~~~ .yN.[,~'~J`'t,J i~; ~+4 ~'«~3y.Y - ~ . / - ic~c-:+~i ....WY:ai:T....~ cr• ~':a~_-J~ti1+.~._ . ti_.:.4_.__' c~ Permft Na. Permk Hakler Dete Talaphone S S/W PLUMBING HVAC ELECTRIC , ' ~dj(cg~ ,~s ~ ELECTRIC Inspection Cate Insp. CommeMs Footings I FoundaUon Framing ~,2Q 9z S' ~I' ~ ~ ' Roofing /"Ot,t ~ O ~ Rough Plbg. Rough Fitg. isui. J/- jc 92 ~ S Ctf/ r. ~vt l~~f.., Firep~ace Final Fftg. Orsat Test Final Plbg. Plbg. Irispector - NotHy Plumber Cor~st. Meter EngrJPlan Bidg. Final 2'f 'Z S' DeGt Ftg. Deck Final Well Pr. D(sp. ~-y 3830 PilOt IGIOb RO di P.O. BOX 2GA 9, Eagan, MN 55121 r~ J d~ +4 ' ~ a PHONE: 454-81Q0 BUILDING PERMIT Receipt# To be used tor Est. Value $ 6~ 0 Q . Date i~~-H 5• , ig Site Address ~ 41 ~lCY V I Gt r C:'I' Erect ~ Occupancy K-~ Lot ~ Block 1 Sec/Sub. SAr~Att 1 L~i~ Remodel ? Zoning Parcel Na. Repair ? Type oi Const Addition ? ~ No. Stories W SONS CONSTRUCTZON CU Move ? ~ength 3$ Mame Z 4 3 7 0 3?AHN RD Demolish ? Depth p~ o Addsess - Int. Impr. ? Sq. Ft City ~A~~Phone ~52-472 ~ Insta~~ ? =o Name ;'AN;r. APProvals Fees ,4ddress ' Assessment Permit $ 319 . G O City Phone Water & Sew. Surcharge ~1_. OU G¢ FD i?:ELZCH Police Plan Review~~ 50 F W Name Fire SAC 5 7 5_ Q U = Z nddress ~ 552 LAKE "ST' v~ Eng. Water Conn. ` ~ 00 <W Cicy ~"'t ~S phone _ 8 66- 3500 Planner Water Meter 63 _ 50 Councit Road Unit y~~ - 00 I hereby acknowledge that I have read this application and state that the B~d . Off. 3/4 / 8 6 Tr. PI. ~ J b• information is correct and agree to comply with all applicable State of 9 Minnesota Statutes and City df Eagan O,~di~'anc@s. : APC Parks Signature of Permittee ' Var. Date Copies r ~ ~ Total e Q 9 4. U t~ SONS CQNSTFtz~CT7OTa Cn A Building Permit is issued to: on the express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and Ciry of Eagan Ordinances. Building Official - ° P~rmN No. Psrmlt Nolder Dat~ TMephona #1 Plumbinq O ~ H.V.A.~. CO~~lp ~ ~lp ElecMc ~ ~ Softener Inapecilon ~ate Insp. Commenb Footinga I Footings II Foundatlon ~ Fremin9 ~//f - C,~J ~G ~,~~i4Y~I~~ . Hoofiny Rouyh Plbq. _ ~ - Z ~C J ~ Rough Hty. ~ ~~//PF ~i~ f e I~k f/r/ sl~i S/~J Insul. Flreplace Final Htg. ~ ~ ~ ~ i . Final Plbq. ~ , Bldq. Final ~ G Cert.Oca f -~G f/~ peck Ftg. Deck Frmg. Well Pr. Disp- ~PERM~I' # CITY OF EAGAN FEE ~ i rn ~ PLUMBING PERMIT _ RECEIPT # v ~ ~ ~ 454-8100 S/C MINIMUM RESIDENTIAL FEE - 510.00 + 5.50 TOTAL DATE `~a~~ MINIMUM COMMERCIAL FEE - S~•~ + 5.50 1. Bldg. Type: Res Comm Inst 2. New Add Alter Repair ';%!'ler•.~ _ r <<'~ 3. Total Bid Price 4. Job Address ` °,i_ f • i. ~r~ 7,~,,~, tot Block Sec S.Owner ' - 6. Contractor ~ I " ~ ~ ~ , , , i _ ~ / ~ . % ~ r C ' = (Name) ~ fStreet) i~~Y) R~P? 7. Contractor Phnne ~t ~ ~ NO. FIXTURES NO. FIXTURES NO. FIXTURES ~ Water Closet - $3.00 ~ Laundry Tray - $3.Q0 -Well - $10.~0 ZBath Tubs -$3.00 ZFloor Drains -$1.50 Private Disp Syst -$10.00 ~lavatory - $3.00 ~ Water Heater - $1.50 ~Rough Openings w/o ' Showe~ - $3.00 -Whirlpool - $3.00 Fixtures - $1.50 ~Kitchen Sink - $3.00 _LGas Piping Outlets - $1.50 -Urinal/Bidet - $3.00 -Softener - $5.00 C~MM./IN~. R E- 1% OF T~TAL BID PRICE PLUS 5.50 STATE SURCHARGE FOR EACH s1,000 OF FEE. i , ~ ~ Signed: - for ' ' ~ Approved Inspections: Date Rough Insp. Date F~nal Insp. PERMIT # ~ ~ ~ ~ ~ ' ' ' MECHANICAL PERMIT RECEIPT # ~ ~ .f ~ ' CITY OF EAGAN , 3830 PILOT KNOB ROAD, EA(iAN, MN 55121 DATE ~`g CONTRACT PRICE: PHONE: 454-8100 Site Address " K ~ ~ ~ ~ ' . BLDG. TYPE WORK DESCRIPTION Lot~~ Block ~ Sec/Sub d'-' ~ ~`y Res. - New ~ Name ~ ~,1~: ~ ' , ~ " ~ ~ -ii Mult Add-on ~c Address ' ~ Comm. Repair c City ~ Phone - pther ~ Name ~ ' ' _ - _ FEES c Address " ~ ' ` ` ~ ' ~ RES. HVAC 0-100 M BTU - $24.00 p City ~ ' Phone ~~~5 ADDITIONAL Sd M BTU - 6.00 ADD-ON AIR CONO. 0-24 BTU - 12.00 TYPE OF WORK ADDITIONAL 6 M BTU - 6.00 ~ M BTU ~c"1 ' J GAS OUTLETS - 1.50 EA. Forced Air - COMM/IND FEE - 156 OF CONTRACT FEE Boiler M BTU MINIMUM - RESIDENTIAL FEE - 10.00 Unit Heater M BTU MINIMUM - COMM/IND FEE - 20.00 Air Cond. M BTU STATE SURCHAFiGE PER PERMIT - .50 Vent CFM (ADD $.50 S/C IF PERMIT PRICE GOES ~ r _ BEYOND $1,000.00) Gas Piping Oudets # Other ' . ~ ~ ' / FEE Z.`; ~ , . ; i . S/C: SIG TURE OF P~RMIT'fEE TOTAL• ~ FOR: CITY OF EAGAN PERMIT # ~a ~ ' PLUMBING PERMIT RECEIPT # ~ = O CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE: ~ ~ CONTRACT PRICE / O C E' PHONE 454-8100 Site Address BLDG. TYPE WORK DESCRIPTION Lot Btock • O 1 Sec~Sub ~ - Res. New m Nam t~ ~ rt -4r Mult Add-on Addre~~ ' • Comm. Repair ~ Ci~'' ~ ~ ~hone633 - o d'~ Other ~ NO. FIXTURES TOTAL Nam ~^'r~~ Water Closet - $3.00 ~ 3 Addr ~ ; r ~ , Bath Tubs - $3.00 p City Phone~-S - 00 Lavatory -$3.00 , Shower - $3.00 FEES Kitchen Sink - $3.00 COMMJIND FEE - 14b OF CONTRACT FEE Urinal/Bidet -$3.00 MINIMi1M - RESIDENTIAL FEE _$10.0p L-aundry Tray -$3.00 MINIMUM - COMM/IND FEE _ 20,pp Floor Drains -$1.50 STATE SURCHARGE PER PERMIT _ Water Heater -$1.50 (ADD $.50 S/C IF PERMIT PRICE GOES Whirlpool -$3.00 BEYOND $1,000.00) Gas Piping OuUets - ~1.50 ~ ~ TSoftener - $5.00 Well - $10.00 Private Disp. - $10.00 Rough Openings - $1.50 SIGNATURE OF PERMRTEE FEE: STATE S/C: ' ~ FOR: CITY OF EAGAN GRAND TOTAL: ~ CITY OF EAGAN $EWQt SERVECE PERM« 3$30 Pilot'Cnob Road - P. 0. Box ~1199 PERMIT NO.: - Eagan, MN 55121 D~?TE: Zaninp: ~ No. of Units: : vab . -~~;ctio;: Owrrr. Address: , _ , , , ~ Site Mdraa: . , - . _ v~.r i ~ . . _ , ; ,~n, Plun~be~: . ' ` j : , . ' i ~ ~ . I y~ ta ~Oh wiM~ 11M C~If? ~f 4~¦ Conrnctio~ Chor~e: - OrJiMSeN. ~P~~~ . P~m~it FN: Suniw~: gy Misc. Choroa: Date of Insp.: Tolnl: Dotr Poid: ~ CITY OF EAGAN WATER SERYICE PERMIT 3830 Pilor C:nob Road ` I P. O. Box 21199 ~ERMIT NO.: ~ Eagan, MN 5'121 D/~TE: j No. of Unit:: ~ons ns ruc on I Owrwr: ew .o~irt a..~r. II Sit~ /lddreu: J um ~ , Plurr~ber. ~ ~O . _ n,~ ~ M~ter No.: ion r9°: . . ~}iyp; ! Size: • LN ~ ~ 20_ ~c. ;.o~~ Reods No.: 0 ~t~g,s~ ~F , pcl ~~l I prr h +~awP~! will~ !IM - ~G~-`°"^ "'ro~~ ; pc. T. C ~ ~~~d met~r ~ ~ ~ ~L~~ , BY Dott Poid: I Dote of Insp.: IwD.: ~r- ~6 CITY OF EAGAN WATER SERVICE PERMIT , 3830 Pilot ~nob Road pE~~T NO.: P. O. Bax 21199 . Esgan, MN 55121 ~~TE~ ~i~. No. of Units: ~ ~WfllR ~ ^ r ~T~3CiUC" , /~I~fQlf: + E S. P ~ ~ ~ . ~ ; r' ~'itlmLfft~ Meter No.: ~ • Si~: . ; Reod~? No.: Psrtnit Fee: . ' i~/wr N~f ~ t~ Gh ~f f~rw Surd+oros: _ - , a~~ Misc. Choro~s: Total: L l BY Dolr Poid: ~ i Date of I~.: S°T( '8(~ REQUEST FOR B.ECfWCAL III~ECTI~tl Ee-ooooi~a ~ sae i~t.nec:ms ro. couo~stim ~a tmm m Ext ot M~os wnr- G~', A*~ ..1(.. Belaw Work ~ ~vered by This Acquest tl !dd Neo- TypaofBuiWiwp Appliancealird EQUiamentMired Home Range Tertiporary Service Duplez Wafer Heater Ligfiti Fixtures Apt &iilding pryer Electric Heati Cmmerciai Bidg. Fumace Silo Unloader I~strial Bldg. Air Cmditioner Bulk Mi~k Tbnk Fa~m ne~ ~he. l5aeci W 1 . ~ ome. ane. ompule lnspec[ron Fee 8elow p Fea Se~+ieeEm'aneeSi=s k faa Feeders/5uWeaders X fce Girc~its Uto200 Om30 Oto30Am A6ove 20D A 31 m 100 N~s 31 to 100 A Swimmi Pool A6ove 100-An~s A6ove 100_A Transfom~s Irtigation Boans Partial•'Other Fee SigRS Special I~pe~.tion n~.~ ~ S 50. SO TOTa. O Roup~-in Date ~ 1, Ly Eleehica ~ f ~ I~apectq. hqra6y oRity thet~ tha aUOVe ii~l inspaetim hss Eapn ' ' ~l6 o.m. nd.~u.oa~e~m.e •tl~IWI1~6~1M1~ SI~/OV • J~ ~i A` 0533(~6 ~ a, 6 Request Datg Fi~¢ No. in I'cpcction Afi.rch 13~ 2986 Qr~ ~~po ~a~ N~ O co'r'Wl~en tleady~C Licereed Elec[riol Conttactor 1 bpa4~ req~st G~paelion o} aAova ? Owner ebcbical ~ort i'cblMd et: Street Addrpss. 80~ pr poure No. CifY 4841 Skyuiem Cort Ehg¢n, Mtnn. ect~on Twn~shi0 Nane a Na Nanpe No. Cmnb Lh.ko t¢ OccupaM Ifl11NT~ PAm¢ No. Sons Construction Co 452-4721 Powar Supplia A~~s lk~.kota I7actric FQrmtngton, Mtnn Eltttriol Contrac[ar ICmW~ry Name) ConbacNr's License No. Neison Electric 041-545-9 Mailinp Addrrss ICOntractar w Ownier Yakinp I~piWtipnl WBbS T Minrt AuMw~ ~groYUe ( clm 1Rakinp tallation) ~one S~v~Z Z7~/ YIN OTA SfA7E BOf1BD OF ElEC7PICfi~' TN~S INSYECTION REUVEST NILL NOT Gripgs-Yidwsy BWy. - Bmm N-197 BE ACCEP7FD B? 7NE STAIE BDARD UMLE55 PpOPEp INSPEC710N FEE IS 7827 Ueirssiq Ava.. SL Peul, YN 5570f Vu..o. f6f2129721f~ ENC~OSED. ~ i~8~ K 2 9 io. ~ 9a- a ' c~ s~`~D Fe uesl D e I Fir o. Roug~-in Inspection I h I ~1 Requiretl9 G Reatly Now `wilhen~Reanspectw ~L~ ] Yes G No ~ 1 1 I~~ licensed coniractor ? owner hereby request inspection ot above eledrical work at: JaE A~tlress IStr e'. BoxCw RoWe No.) /a , Ci~y_y- il 1 C-" ( ~/~l'7 1 /'1 ln La ~ ~ L~l:/~/ Section No. TownS1NpN~am.e or N~o p/~~ Range No. Fy" ~"V ~ ~ OccupantlPRINTI Phone o V~~ CJIO' Power SupPher Atltlress Ele ¢al ConVacor IGOm + n ~ ConVU or's Licen ~.Na ^ ~'r ~J'L Maihn AG ss lGOmraGar•er Owner Making Installationl ~~1~1 ~~Z~yviir! ~ Auifidnze0 Signd~ure~ ConvacmnOwn.e~,~ a^ki~n/g' InstalYatdn~ P~one Num er ~ ~~,~~"L~/~ MINNESOT.~00AP0 OF ELECTqIGTY THIS INSPECTION REOUEST WILL NOT Griggs~M W~ way BfEq. = Roam 51~3 BE PCCEPTEO BY THE STNTE BOARD 1821 Unive~lry pve., St. Paul. MN 55104 ` IINLESS PROPER INSPECTION FEE IS Plwne (81]) 602-0800 ENGLOSED. ~~j9~ REOUEST FOR ELECTpICAL INSPECTION ~~B ~al~ ? See instmctions for completing ~nis form on becM oi yellow copg t~ ~ 1~ 'X" Below Work Covered by This Request w+~ ' ~ ew Atltl Rep. TypaofBuilding AppliancesWired EquipmentWired Home Range Temporary Service Duplex Water Heater Elechic Heating ApL Buildinq Dryer Othec(Specily) Comm.llndustrial Fumace Farm Air Conditioner Omer(speciry~ Contractor'sRemarks:~^,-^^ 1.I~IrI ~ ~ u~-.~i ~ ~ ~/1 ~wt Compute Inspection Fee Belaw: 1«.G~ ~"~J 4 Other Fee # ServiceEntranceSize Fee # Circuits/Feede}s Fea Swimming Pool 0 to 200 Amps o to 10o Amps Transtormers Above 200 _ Amps A6ove 100 _ Amps Signs ~nspecmr's use onry: ~ O 70TA~ Irri9ation Booms Special Inspeclion Alarm/Communication TMIS INSTALLATION MAV ORDE E DI~CONNECTED IF NOT Other Fee COMPLETED WITHIN 1 TH . I, the Electrical Inspector, hereby Ro~n-~~ , aie 0~ ~ certiy that the above inspection has F;nei ~ oa~a been made. - OFFICE USE ~NLY ~ This request voitl 18 months irom CITY OF EAGAN • ' 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 N°- 115 71 PHONE: 454-8100 ~ Da f / BUILDING PERMIT Receipt# <0 7obeuaedtor SF DWG/GAR EstValue $102~000 pa~e MARCH 5, ,~y86 4841 SRY VIEW CT a7 R3 Site Add~ess Erect tJ Occupancy Lot z 61ock 1 sec/sub. SAFARI 2ND Remoael ? zoning R1 Parcel No. Repair ? Type of ConsL Addition ? No. Stories a SONS CONSTRUCTION CO Move ? Length ~8 z Name Demolish ? Depth ~ 4 o Address 4370 RAHN RD Inl lmpr. ? sq. F~. Ciry EAGAN phone 452-4721 mstal~ ? o Name S~E Approvala Fees Address Assessment Permit $ 319.00 ~ Ciry Phone Water 8 Sew. Surcharge 31 . 00 ~ ED MELICH Police Plan Review 159.50 ~ W Name Fire SAC 575.00 address $552 LAKE ST Eng. WaterConn.~00 g W ~~ry MPLS pnone $66-3500 p~anner Water Meter~~.50 Council Road Unit 290. 00 Iherebyacknowledgethatlhavereadthisapplicationandstatethatthe Bid9.off. 3/4/86 Tr.PI. 156.~~ i~formation is correct and ag ee to comply ij1 all ap li able Slate of Minnesota Statutes antl C /E_agan fi e. APC Parks Si nature of Permittee Var. Date Copies 9 Total 00 SONS ONSTRUCTION CO A Building Permit is issued to: on the express candition that all work shall be done in accordance with all applica S~ta~t~ 1 M,,inpnes~ota tat tes ~ of Eagan Ordinances. Building Official ~y$~CSGiic~c--C-. ~ /.~t/-Ya~t.~ 2004 RESIDENTIAL BUILDING PERNIIT APPLICATION City Of Eagan 4~ u i 3830 Pilot Knob Road, Eagan MN 55122 ~ Telephone # 651-675-5675 FAX # 651-675-5694 NewConsWdionReavirements RemodelRteoairReauiremeM.s Olfi 'U 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all rooted areas 2 coDies of plan CedofSuruey Recd Y; _ P7 (20Yo mauimum btcoverage albwed) t set of Ene~gy Calculations for heated additions 7rce PresP{an.RecG ,_Y _N 2 oapies of plan showing beam & window sizes; poured found design, etc. 1 site survey tor addroons & deda Tme P[es Requlred ~_Y,.=N isetofEnert~yCakulations Addflion-indicafeifan•sitesepficsystem Onsde,~ey,'~,ic3y5tem~~~„`,.1I.,~A7 3 copies of Tree Preservatbn Plan i( lot platted atter 7/1193 Rim Joist Detail Options selecUon sheet (hldgs wiN 3 or less units Date / ~ "T / ~ ! Construction Cost ~ ~ ~ ~ ~ ~ Site Address ~g~ ~~kl~ V1'~VJ CBLIY"~ UniUSte # DescriptionofWork `{'Q(~YC7t-t- QI(lG~ 1~'~~CJ-Y h8~/~ ~/Q?~~ Multi-Family Bidg _ Y ~ N Fireplace(s) _ 0 _ 1 _ 2 Property Owner ~~VY~ l~Q,' ~~~R~ Telephone # ( kj5~ ) ~~9 - ~~D ( Walker Roofing Compaz~y, Inc. Contractor 2274 Capp Road Address Saint Paul, M~I 55114 City State (651) 251-0910 Lip Telephone # ( ) - State License # 4229 - Exp 03/31/05 COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672 Energy Code Category , Residential Ventilatlon Category 1 Worksheet • New Energy Code Worksheel submission lype) Submitted Submitted • Energy Envelope Calculations Submitted Have yo~ previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review fee applies. Licensed Plumber Telephone # [ ) Mechanical Contractor Telephone # ( ) Sewer/WaterContractor 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 wor ~ zs L eq~ ~res~ a revi~w and approval ofplans. ~ ~ ~ ' ~ ocr 1 ~ 2004 ~ 1)~,~nv~ ~ ~ < ~ ~ Applicant's Printed N e ic ' Signature I ~ ~ " RESIDENTIAL BUILDING Permit Application City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 a I~j ~~s Telephone # 651-675-5675 FAX # 651-675-5694 New ConsWction Reauirements RemodeVReoair Reauiremen}s ~ce Use OnN 3 registered sHe surveys showing sq. ft. of bt, sq. ft of house; and ~II roofed areas 2 copies of plan Cert of Suney Recd _ Y_ N (20%marzimum lol coverage allowed) t set of Energy Calculadons for heated additions Tree Pres Plan Recd _Y _ N 2 mpies of plan showing b~m & window sizes; poured found design, etc. 1 site survey for addilions & decks Tree Pres Reqd _ Y_ N isetotEne~gyCalalations Add'rtion-irMkatedon-sNeseptlcsystem On-site5epticSystem _Y _N 3 coples of Tree P~eservation Plan if lot platted aRer 717193 Rim Joist Detail Options salection sheet (bldgs wBh 3 or less unils Date /~1 Construction Cost -~OC~'~ R,~ Dc9c~m SiteAddress ~-I~~i1 SIlYY1fivJ ec~a~R7 UniUSte # Description of Work pp2i~p~. I~innGi.Db ~Su.~.2dd~.~ lZ6iii]8 3A7~Pri' ~iaEr1C Multi-Family Bldg _ Y N Fireplace(s) _ 0 _ 1 _ 2 Property Owner ~p~~w p.i Telephone #((~s/ ) SlS(e- d0[. / COLt['BCtOt' ~CEw1A~LSANLE '~'~X~P2W2L Address 2S5(e 1-1WV 10 City Mau~aty ~g~/ State ~iq~ Zip ,5",5~~ Z Telephone #(7y3 ) 7&p - 7~op COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 Catesorv 1 Minnesota Rules 7672 Enefgy COde Category . Residential VentilaUon Category 1 Worksheet • New Energy Code Worksheet (J submission type) Submitted Submitted . Energy Envelope Calculatlons Submitted Have you previousiy constructed a building in Eagan with a similar plan2 _ Y _ N If so, 25% plan review fee applies. Licensed Plumber Telephone ) Mechanical Contractor II I~~ o~e # ( ) Sewer/Water Contractor ~ ~ ~ ~ u ~ le ~ I e # ( ) ~ O~T 1 3 ~003 ~ J I hereby apply for a Residential Building Pernut an~a~knowledge that the i ormation is complete and accurate; that the work will be in conformance with the ordinar[c~ co e e~ 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 approva] ofplans. M,a.a~c 1~e3oE Y Applicant's Printed Name Applicant~s Sign~~~ PERMIT ° 119 8 ~ ~ITY OF EAGAN 3830 Pilot Knob Road PERMIT TYPE: r~ u z ~ n~ N e Eagan, Minnesota 55123 Permit Number: 0 01. 6 4 8 (612) 681-4675 Date Issued: 10 / 16 / 9 2 SITE ADDRESS: 4841 SKY V]:EW CT LOT: 2 BLOCK: 1 SAFAftT 2Np DESCRIPTION: CONVERT SCREEN PORCH u i 1 d~z`n.g P e r m i t T y p e S F P$ftCti ~~'~'"~'L' ~ Buildinq''Work 'lype ALTERRI'TON UBC Occupancy R-3 ~ _ ' .j , (`r i ~'l.\~,% ~r'ii~ ~l ' ~ii 1. ',I i~ ' \ t A L. . ;_r`':_~ LJ REMARKS: ftEC~TPT SEPRRATE PE~RhIIT REQUtiREO FOR ELECTRICAL FEE SUMMARY: VALUATION $7,000 Bas~ Fee $90.a0 Surcharge $3~50 Total Fee $93.50 - CONTRACTOR: - Applicant - sT. ~I OWNER: SATHER CO D M 19357989 00f~37% GALLOWAY .]IM 7920 POWELL RD A841 SKY VIFW CT HDPKINS MN 55393 EAGAN hIN (512) 938-7999 (612) I hereby acknowledge that I h~ve read this applicat9.on and state that the information is correct and agree to comply with a11 applicable State ofi Mn. Statutes and City pf Eagan Ordinances. ~ ~ ~a.~'~~~,~~.to-tr'' APPL ANTIPE ITEESIGNAA T, U E ISSUE~BY: ATURE INSPECTION RECORD Z~- 9$ CITY OF EAGAN PERMIT TYPE: a u r i_ i~ z n~ r 3830 F'ilot Knob Road Permit Number: 0 0:1. 6 n rs Eagan, Minnesota 55123 Date Issued: 1.0 / 16 / 9 2 (612)681-4675 SITE ADDRESS: ~ o r: z ~ ~ o c : 1 APPLICANT: 9841 SKY VIEW CT SATHER CO D M SAFARI 2ND (612) 938-7989 PERMIT SUBTYPE: TYPE OF WORK: SF PORCH ALTERNTTON DFSCRIPTSON CQNVERT SCREEN PORf . „ . FRAhIING INSULATTON FINA~ REMARKS: RECEI:PT # SEPARATE PEF2MIT REQUIRED FOR ELECTRSCAL ~ ~ • . - PERMIT ~ CITY OF EAGAN REACTIYA?~ _j~ / 1992 BUILDING PERMIT APPLICATION ~ 681-4675 OCT 1 3 &'~cn~ SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy • calcs. COMMERCIAL 2 sets of architectural & structural plans, 1 set of specifications, 1 copy of energy calcs. Penalty applies when typing of permit is requested, but not picked up by last.working day of month in which re uest is made or lot chan e is re uested once ermit is issued. Date ' 3 Valuation of work ~~~G~ Site Address: ~ S~~l~ f'o vi T" STREET SUfTE / Tenant Name: (commercial only) LOT gIACB SUBD. '~1 P.I.D. ik Descri tion of wark: °y""~f'~ ~ 5~~~ ~`c ~ ° ' 5~~~6 °f~ ~ The applicant is: 0 Owner Contractor ? Other coeseribe~ Name J~,~ -r Sah~<ti G=:./(ow~c;~ Phoi~e Property «S7 F~RST Owner pddress 5~~.~ ~"Q~ ~ STREET . STE M City _ ~~~~N State !~/~l Zip CompanY ~ ~ l~ a , ~l~ Phone ~3a~-~~ ~ CO~t~BCtOY Address 7~2-~' ~rz~~ License # 3'~~ Exp. City _ ~,~~op~K._s State j~%-- Zip SS'7~1 S Company Phone ? ArchitecU Engineer Name ' Registration N J Address - City ~ State Zip Sewer 6 water licensed plumber Processing time for sewer ~ water permits is two days once area as een approved. 1 hereby acknowledge that I have read this aPplication and state that the information is correct and agree to comply with all applicable 5tate of Minnesota.Statutes and City of Eagan Ordinances. , 5ignature of Appl icant: /lfa~,~,~., ~//J~i~ ~ ~ OFFICE USE ONLY BUILDING PERMIT TYPE ? O1 Foundation ? 06 ~uplex f7 11 Apt./Lodging O 16 Basement Finish ~ 02 SF Dwg. ? 07 4-Plex ? 12 Multi. Misc. O 17 Swim Pool ? 03 SF Addit9on ? 08 8-Plex ? 13 Garage/Accessory ? 18 Comm./Ind. ~A4 SF Porch ? 09 12-Plex ? 14 Fireplace O 19 Comm./Ind. Misc. ~O 05 5F Misc. ~ 10 Multi. Add'1. O 15 Deck O 20 Public Facility ? 21 Miscellaneous WORK TYPE ? 31 New '~33 Alterations ? 35 Tenant Finish ? 37 Demolish ? 32 Addition ~O 34 Repair ? 36 Mave GENERAL INFORMATION Canst. (Actual) Basement sq. ft. MWCC 5ystem (Allowable) lst F1. sq. ft. City Water UBC Occupancy 2nd F1. sq. ft. PRV Required Zoning 5q. Ft. tatal Booster Pump of Stories Footprint Sq. ft. fire Sprinkler Length On-site well Census Code ~ Depth On-site sewage SAC Lode APPROVALS ~~3 h~~~ ~ .~,.,~:b o Planning Bullding Assessments Engineering Variance RE~UIRED INSPECTIONS CC-ow~v2T ~n~~A 7~ 3 s~af~ah/ ~Ce~osy~ ? 5ite ? Footing ~ Framing ~Insulation ? Nallboard ~Final ? DraintiTe ? Fireplace Permit Fee Q ~v voiuec;o~: $ 700Z~ Surcharge ~ ~ Plan Review ~ ,~2 j~(~( ~ ~5S )C CyS -2S~ = License MWCC SAC City SAC Water Conn~. Water Meter . Acct. Deposit 5/W Permit S/W Surcharge Treatment P1. Road Unit Park Ded. ' Trails Ded. Copies Other Total: SAC % SAC Units : ~ ~ ~ 1986 BQILDING PERlIIY APPLICATIOH - CITY OF EAGAN NOTE: ALL C09TRACTORS (~IQST BE LICENSED IiITH THB CITY OF EAGAaI CONIliERCIAL SINGLE FAPIILY DTdE[.LINGS INCLUDE 2 SETS OF ARCHITECTURAL INCLUDE 2 SETS OF PLANS & STRUCTURAL PLANS~ 1 SET OF 3 CERTIFICATES OF SURVEY SPECIFICATIONS AND 1 SET OF 1 SET OF ENERGY CALCULATIONS ENERGY CALCULATIONSJ $2,000 LANDSCAPE BOND To Be Used For: ~ ~?:e . Valuation:~ Date: 3-- ~3 - ~ ~ Site Address `7~ y/ - J lc ~~j.~ ~ OFFICE IISB ONLY Lot L Block Ereet X Oceupancy - R~3 Aemodel _ Zoning I Parcel/Sub S~k F~4 iZ 1 Z~~"' Repair _ Type of Const ,S[ Addition l~ of Stories Owner ~o ~v1' ~G q;~S T ~o Move Length ~ / Demolish Depth Address ~j"7G ~Af//J ~Lt~ Int.Impr. . Sq Ft T- Install City/Zip Code G~4(~r.4i~ Phone )5~ - ~7,2 ~ APPROpALS FESS Contraetor SGiJI ~~c.u.rT' Assessments Permit 31~. Water/Sewer Sureharge Address `737G ~/4f//„~ ~LCX Police Plan Review I S`i. Fire SAC S'IS. City/Zip Code ~'~4Cg,4/~ Engr Water Conn Soo. Planner Water Meter to3.$D Phone ~y - Council Road Unit Z`ID. /J Bldg Off~- Treatment Pl 15l0. Areh./Engr. ~c%e fYJe.L~ APC Parks Variance Copies Address ~5 ~ ~ _ ~.4 ~e S'~ City/Zip Code dyi~r~ Phone l~ d" 3~~ 0 NOTS: ADDHESSES POR COHPEB LOTS - COATRACT09/HOMEOiiRER MQST DFSIGHATE iiHIC9 ADDRESS IS DSSIRID. NO CH9NGES iiILL HE ALLOiTSD ONCE HQILDING PERMIT IS ISSDED. 24x~ '.~'~4x ~ " ~o~t2 ~ ~ • i ~ ( ~ = I og S8 ~ C~Z~ ¢ . 2o,c2o ~ Kc2 - 480~ ~c r-~c~ , . ~ TRI-LAND C0. SURVEYING SITE PLAN FOR: SERVICES SON'S CONSTRUCTI~N, INC. 4655 NICOLS ROAD EAGAN, MINNESOTA 55122 0 J 8~° s0~ a ~ 8j9~ 2 E r~_.~~.~ ~ ~ ~ I ! N ~ ( I I ~ , LOT 2 ~ Q:'a I ~ ~ W W SCALE~ I"= 30' Il ~ I n'' ,~q ~ p O ~ N V~ OOfy ~ I ~ Housc ~ 1 a c ~ m ! C~T I r'"~ ,~0 ~ I i I ~ Cnt~ac ~ ~o I _ r ~ l S a ~ ~ Bg.vJ A~r e N 76O15T'4~" F e w w o SKY y VIEW COURT ao PROPERTY DESCRIPTION I LOT~, BLOCK~, SAFARI SECOND ADDITION aecordinp to tMe recorded plaf thereof DAKOTA Can~y, Minnesoto LEGEND o DENOTES IRON MONUIY~NT PROPOSED GARAGE FLOOR EIEVATION =/o~_Qo o DENOTES WOOD HUB SET PROPOSED FIRST FLOOR ELEVATION = DENOTES EXISTING SPOT PROPOSED BASEMENT FLOOR = ELEVATION ELEVATION DENOTES PROPOSED SPOT ELEVATION ~ DENOTES DRAINAGE OIFtECTION NOTE ~ VERIFY ALL FLOOR HEiGHTS WITH FINAL HOUSE PLANS I harsDy csrtify,thaf ihis survsy,plan or rspwt wos prepcred by me or under my - direct suparvision and that I am a duly 8radiey Swenson, Mn. Req. No. 15235 Repiste~ed Land Survhror ut~dsr fhe ~ Lows of the State of Minnesota. Oate ~ 3~~/86 ~ Y. . . ; ~ _ j . , EXTERIOR Et1V~'*,C^~ AVERAGE '~U' COiI?[ITATIQ;? - Oi~JIJF':l ~UIJS ~'(1.STYZI„CCeT /C+At~ SI1~' ADDRESS_ 4841 Sky View Court, Eagan, Minn. - CONTRACTOR ~-~ti , C . ~ - r} , , ~ - DATi_ 'I?OtIE `I ~ ) - `/J:' l ~ - Determine vrorking square Sootage of each. 1. Total ex~osed wall area ....1?_I ~ sq. ft. x,11 2. Tot31 roof/ceiling area `i ~~,5' sq. ft. x.026 i Total exposed wall area above floor a. Total wall vrir.Zc•r~ area 1~~~~ b. Total door area ).~-7 c. Tota1 sliding glass area d. Total °ireplace vrall area e. Total wall frar~ing area (average 10~)... /=/<< f. Total net wa1Z area above floor ~/,3 g. Total ri~: ~oist area . . . . . . . . . . . . . . . i ? r~~ u Total exposed foundation area = h. Tctal foun3ation i•;indow area i. Total net foundation area above g^ade .'7 Determine "U' value of each tiaall segment. a. IIG.r.+~~"x „U~: ,y3 ~ `~9.i~ b. '-3').I i X ~,Uf~ - '~IiL' C. ~ '/l~. X ~'U'' ~i'% _ = 7 ~ -y' D. X "U'` ° e. /~..c~C. X ~.U~~ ~ _ l~~~. f . ~ X „U~: c = c . g, i ; . X nU•- ~ F _ . ha. X ;~U~. . ~ . 1• ~T_ A IiTTII 6 1) . V 3 .................:..........................Tota1 ~ ~,z If iten #3 is the same as, or less than item ~1, you have met the intent of ~BC G006(c)2. • r ~ . ~ ~ Total exposed roof/ceiling area = ~,S"~~ ? ^otal skyli~ht area ic. Total roof/ceiling framin~ area~(average 1G,) 1. lotal net insula~ed reo:/ceilir.e area Determine "U~ value for each roof/ce±ling se ~^ent. , - X ~.U, _ k.~X '`U" ,~~~i 7(~~ _ ~~,.7~~ 1. :1 1') X,:U~, ,c~ z~l = ~L %3 4 .........................................Tctal = ;~~r.t;'~ Zf total o: f# is the sa:~e as, or less than f2, you have met the intent of SBC 6006(c)1. Alternate Buiidiiig Envelone Desit,n To utilize ihe total envelope syster,. nethod, the values establishe~ by the sun of items ~f3 and ~=1 shal:: not be greater than the sur.:.of itens ~1 and i:2. " 1. + 2. _ 3. + 4. _ • ~ ~ ~ • i e~ e i~• • u r a~. • 71• s • • ~ ~ • • • • • al~ • 1 1 1 ~1 • • . p Y • ~ CITY OF EAGAN APPLICATION FOR PERNIIT SEWIIt ADID/OR WATER CONNfX.TION 1) PROPII2TY ADDRFSS: J,~ ~i~/ ~ P~nt) ~4QG~ 7•FY:AT. DFS(ItIP'i'ION: (Lot Block Subchvision or Tax Parcel I.D. Number) IF EXISTING STRPCT[JRE, DATE OF ORIGINAL BLILDING PERMIT ISSC'ANCE: (Nbn Year) PRESENf 20NING/PROPOSID DSE: R-1 SINGLE FAMILY R-2 DCPLEX (ZWo L'nits) R-3 ~WNHOL'SE (Three + Lnits) ( Units) R-4 APARTMENT/CODIDOMINIC~M ( IInits) CONA"IERCIAL/RETAIL/OFFICE I[~IDOSTRIAL INSTI'1L'TIONAL/GOVII2~A~NT 2) ~ ~a~ OIS dh ~D~ss: ~ ~ 7'0 a G.~, ~r o~ CITY, STATE, ZIP: ~Gac~ /~/V PHONE: /1 j'a ~ t 3) ' r.~' ~ For City Dse N~' G Plumbers License ADDRESS: L~( Active CITY, STATE, ZIP: /~2Q.~~~~i~~ ~ G7 ExPired PHONE: CLI~ ~ 0'~9~ MASTII2 LICINSE #~Z~,~ / O Not Recorc ~ Staf~initial 4) • ~ ~ O/sa~ Ao~RE'ss: ~/t7 >O /pd%.r~r /~rD CITY, STATE, ZIP: ~O 2t2 PHONE: [~SZ 5) ie a • a• • • ~CON[~TION 'I1~ CITY SEWER ~CONNECTION TO CITY WATII2 Q OTHIIt (Please Describe) 6) u • • ? PLEASE HOLD APPROVID PERNLiT FOR PICK-C'P BY ONE OF AHOVE ~ PLEASE MAIL APPROVFD PERMiT Zq 1, 2,~ 4, AEOVE (Circ one) ~ r~ _ 2 F O R C I T Y U S E O N L Y ~ PE2MIT ISSUED ~ F°~S: $ ~D ~ S U S~i'JLP. P°R?7T_T (I`IC_L~DE SURC?i?~GE) . $ I~' S~ W~TEc2 PERI~1IT (IP7CiiTDE Sli~CF.~RGB) $ (v.3 5 ' WATER i~1ETER/COPPERHORN/OUTSZD~ READER $ WATER TAP (INCLUDE CORPORATION STOP} S S::vEF T~P S ~7 CD ~r~~•i.:'.'I~ GSi= - : $ O I+ ACCOUNT D`:P(~SIT - 47ATE~ S _a O C~ (J' Z~ WAC $ ~ S ~r n SP.C $ TRGNK NAT~R ASSESSi1E:dT $ TRlii~K SESdER ASSESS.IE:IT $ LP,TE?.aL BE:IEFIT/TRUNIC SE~:~R $ LATc:~IL BENEFIT/TRUNK NAT°R $ ~ S~'~ ~ WATER TREATMENT PLANT SURCHARGE $ OTHER: $ TOTAL - S ~S UZ P.rSOUJ~T PAID ~ 1 D~/' ~ /REC..IPT e /O~.t~t~ ~D~'Q~ DOES tlTILITY CONNECTION REQUZRE EXCaVATION IN PUBLIC RIG~iT OF WAY? ~ YES IF YES, THEN A"PERMIT FOR 'r10RK WITHIN PUBLIC ROADWAY" MUST BE ISSUED BY THE C] NO ENGINEERING DIVISION. LZST AS A CONDI- TION. SUBJECT TO,THE FOLLOL4ING CONDITIONS: APPROVED SY: ~2,~,.~ y~,•,-,~7.,~ - TI;LE: DRT° : . ~ ~ i----------------~ ~ Permit#: ~ City of E~~a~ ' 1 I I 3830 Pilot Knob Road f Permit Fee: I Eagan MN 55122 ~ DateReceived: j Phone:(651)675-5675 ~ I Fax: (651) 675-5694 ~ g~~; , 2008 RESIDENTIAL PLUMBING PERMIT.APPLICATION Date: Site Address: Tenant:. Lizann Rieder 4841 Sky View Court _ suite RESIDENT! OWNER Name: Eag~. ~ 55122 6123876925 Address / City ( Zip: CONTRACTOR Name: ~ Lfcense D lL l~t Address; 1 O~ (L[.~'TI p~ ~l'v ~ 7?11 City:_~~5, State: rv~rni Zip: ~ D Phone:~ W I L~~!~~ •~fp33 Contact Person: ~e O~J TYPE OF WORK _ New _ Replacement _ Repair _ Rebuild _ Modify Space _ Work in R.O.W. Descriptlon of work: PERMITTYPE RESIDENTlAL X Water Heater Water Softener Lawn Irrigation Add Plumbing Fixtures L RPZ PVB) ~ Main _ Lower Level) _ Septic System Water Tumaround New - Abandonment RESlDENTIAL FEES: $50.50 Minimum Water Heater, Water Softener, ,or Water Heater and Softener (includes $.50 5tate Surcharge) $3U.50 Lawn Irrigation (includes $.50 State Surcharge) $50.50 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround` (includes $.50 State Surcharge) 'Water Tumaround (add $136.00 if a 5/8" meter is required) $100.50 Septic Systerrl New ($70.00 per as built) (includes County fee and $.50 State Surcharge) $90.50 Fire Repair (replace bumed out appliances, duchvork, etc.) (includes $.50 State Surcharge) 5 O TOTAL FEES $ SO, I hereby acknowledge that ihis infortnaUon Is complete and accurete; that the work will be In conf ance wkh fhe ordlnances and codes of the City of Eagan; that I understand ~this fs not a perznit, but only an appliration for a pertnit, and wo s not to start wi t a permf~ that the work will be in , accordance wifh the approved plan in ihe case of work which requires a review and appro of pl X_._ ~.~~i~''~e,~1 N oY bl m-~~. x ApplicanPs Printed~WSme pppl' anYs Signature • +~yF"x.'~ Y., b~ .rvY~2fiFn$'F'lyR&r . FOR O F,((t.~"lI'~ ~ > 'k~.1 rhr-~ ~ v 7, n ~ a ~'~~+'m~~,~ e~` f ~ e e ~ 'D~3 ~s,. 4 V',~~ ~ ecf~p i ~~'1~ - P d i :7 : g g: a p; a~' . - CASH RECEIPT ~ ~ CITY QF EAGAN ~ P. O. BOX 21-199 EAGAN, MINNESOTA 55121 DATE 19 RtC~V6D iRpM AMOUNT $ I a oo~~wws ~oo ? CASH CHECK FOR ' t F4ND CODE AI~OUNT lf ~ . i Thank You BY ~r ' VYhite-Payers Copy Yellow-Postinp Copy Pink-File Copy r City of Eapll 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use Permit* r3-)1(61 Permit Fee: (01') Date Received: Staff: 2015 RESIDENTIAL PLUMBING PERMIT APPLICATION Dater 0j —17 /65 Site Address: 'i$ztt( ( It7 Tenant: Suite #: Phone: Name: 6e 4,,r,[..QA �g .P . G/. License #: €c l3,zo il=.• Contractor Address: c�� /^0 j'e- .,"1 City: State: 7�,c Zip: b�7 Phone: Contact: Email: New _ Replacement V' Repair _ Rebuild T Modify Space _ Work in R.O.W. Description of work: RESIDENTIAL Water Heater Lawn Irrigation ( RPZ / _ PVB) Septic System New Water Softener Add Plumbing Fixtures ( Main / _ Lower Level) Water Turnaround Abandonment RESIDENTIAL FEES: $60.00 Water Heater, Water Softener, or Water Heater and Softener (includes State Surcharge) $60.00 Lawn Irrigation (includes State Surcharge) $60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes State Surcharge) *Water Turnaround (add $280.00 if a 3/4" meter is required) $115.00 Septic System New (includes County fee and State Surcharge) TOTAL FEES $ CALL BEFORE YOU DIG. Call Gopher State One Cali 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. Applicant's Printed Namee2-tE(7 Applicant's Signature FOR OFFICE USE Required Inspectio r Related Items: Meter Size Radio Read Manometer Staff: PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA162395 Date Issued:07/13/2020 Permit Category:ePermit Site Address: 4841 Sky View Ct Lot:2 Block: 1 Addition: The Safari 2nd PID:10-75851-01-020 Use: Description: Sub Type:Residential Work Type:Replace Description:Air Conditioner Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088 Surcharge-Fixed $1.00 9001.2195 $60.00 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Erik Olson 4841 Sky View Ct Eagan MN 55122 (507) 382-5566 Controlled Air 21210 Eaton Ave Farmington MN 55024 (651) 460-6022 X253 Applicant/Permitee: Signature Issued By: Signature