1365 Towerview RdCASH RECEIPT
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGANt MINNESOTA 55122
i DATE ' - r% ? ? _
AMOUNT $ 17
-& -DOLLARS
_` gee
? CASH ? CK
White-Payers Copy
Yellow-Posting Copy
Pink-File Copy
Thank You
63809r
BLDG.
01-3210'
01-3422
01-3445
01-3446
01-2155
17-3860
20-2275
20-3865
20-3868
20-3716
20-2252
20-3713
20-3743
79-3866
11-3855
Fy R M I T NO
.
J !
Bldg. Permit
Plan Check
Surch./Adm.
SAC/Adm.
Surcharge
Road Unit
SAC
Water Conn.
Water Trmt.
Water Meter
Acct. Dep.
Water Permit
Sewer Permit
c.; J
Sewer Conn.
Park Ded.
T
i
i
TOTAL
?J" 1
CASH RECEIPT
CITY OF EAGAN
3795 PILOT KNOB ROAD
• EAGAN, MINNESOTA 55122
?J r
DATE C/
19?
RECEIVED/ "
FROM(C
AMOUNT Is & DOLLARS
loo
? CASH [] CHECK
FOR
FUND CODE AMOUNT
Z G z -z D o?
;71 _3
iv
J
37 V /v o
V445-
0
Thank You '
66235
White-Payers Copy
Yellow-Posting Copy
Pink-File Copy
CITY OF EAGAN
't 3830 Pilot Knob Road, P.O. Box 21-189, Eagan, MN 55121 n4 ID
121 5
PHONE: 454-8100
BUILDING PERMIT Receipt #
To be used for SF DWG/GAR Est Value $135,000 Date aUNR 18 19 6
arcel No. Repair ? Type of Const U33
Addition ? No. Stories 52
Name RIVERVIEW CONST Move ? Length
53
o Address 9 5 0 6 R I VERV I EW IDnttrimprh ? Sq. Ft
City BLMTN Phone 888-1365 Install ?
Address
City Phone
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.
..... ... :rte// !
A Building Permit is issued to: tc i
all work shall be done in accordance with all
Building Official
Approvals Fees
Assessment Permit $ 520.510
Water & Sew. Surcharge 67. 5C
Police c
Plan Review
' U
Fire s
f
SAC
: 0(
Eng. Water Conn.
5(
- '0
Planner .
Water Meter
10.0 (
Council
6/11/8 Road Unit
• 0I
Bldg. Off. Tr. PI.
APC Parks
-Var. Date Copies $2, 432 .7!
Total
on the express condition that
i Statutes and City of Eagan Ordinances.
Pwwo" I PwwM Helder I DsW I TWohwn A 1
Final
DYp.
r• PERMIT # 7
• PLUMBING PERMIT RECEIPT # y/
CRY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE: A
CONTRACT PRICE PHONE 4544100
Site Address C I-c- ?- BLDG. TYPE WORK DESCRIPTION
Lot d Block Sec/Sub ,
Res. New
m Name _ _ d? ?? 7 Mult Add-on
Address Comm. Repair
c City y ! Phone -1 ' ''' Other
m
c
3
O
Name _
Address
City -
v e
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
MINIMUM - RESIDENTIAL FEE _$10.00
MINIMUM - COMM/IND FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1.000.00)
FOR: CITY OF EAGAN
NO. FIXTURES TOTAL
Water Closet - $3.00 1
Bath Tubs - $3.00 '
Lavatory - $3.00 '
--L-Shower - $3.00
Kitchen Sink - $3.00
Urinal/Bidet - $3.00
=Laundry Tray - $3.00
,_Floor Drains - $1.50
Water Heater - $1.50
Whirlpool - $3.00
Gas Piping Outlets - $1.50
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
-i-Rough Openings - $1.50
FEE
STATE S/C:
r ` y
GRAND TOTAL-
Site
co RECEIPT#
.. CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, M
ICE:/BO - PHONE: 454-8100
BLDG' TYPE WORK DESCRIPTION
Block CZ_ Sec/ b Kl;r
Res. y/ New
` Mult Add-on
Comm. Repair
Phone Other
f j 4? '_?D, J1
TYPE OF WORK _
Forced Air A90 •? 06 / l M BTU
Boiler M BTU
Unit Heater T? M BTU
Air Cond. 7"'?"`? M BTU
Vent 3 ?? i? CFM
Gas Piping Outlets # _L
Other
FEE
S/C:
TOTAL
FEES
RES. HVAC 0-100 M BTU -$24.00
D ADDITIONAL 50 M BTU - 6.00
ADD-ON AIR COND. 0-24 BTU - 12.00
ADDITIONAL 6 M BTU - 6.00
GAS OUTLETS - 1.50 EA.
COMM/IND FEE - 1% OF CONTRACT FEE
MINIMUM - RESIDENTIAL FEE - 10.00
MINIMUM - COMM/IND FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYON[T$1,000.00)
? SIG /CTURE OF PERMIT E
!04 0_6 II
PERMIT # -7 -3
N 55121 DATE
FOR: CITY OF EAGAN
CITY OF EAGAN WATER SERVICE PERM
3830 P'L-C Knab Road
P. C Sox 21198 PERMIT NO.:
Eayao, MN 55121 DATE:
Zoning: No. of Unitr. 1
Owner. Riverview Const.
Addrew
Site Add u: 1365 Towerview Road L2 B2 T.e";, L,:ke Hilts
Plumber. Thoe: P1 ,ml,inv_
Meter No.: ion Charge: 5 i) U . r.
.! 1.5.00n<
1 10.00 d
o8no too" Mal W1116 the E . 50 d
?EIE? ,?- 156.00nd Tt>
63_50nd meter
Dote Paid:
of Insp.: Insp.:
CITY OF EAGAN WATER SERVICE PERMIT
3830 Pilot Knob Road
P. O. Box 21198 PERMIT NO.:
Eagan, MN 55121 DATE: -
Zoning:. No. of Units:
O
wner:
Addr as:
Site Address t (? ^Qc %- r v i„ F v a 6:e -Iii-11g
Plumber.
Meter No.: Connection Cha rge: T '? '?4
Size: Account Deposi t:
Reader No.: Permit Fee: ?' • ()D?,d
I a9m to newly wllh the City of Saari Surcharge: . 5 Qpd
Odlaaaeee. Misc. Charges: 1 `6 ,1QUd T'
Total' ( - _ r A,,. m'- t P r
By
Dote of Insp.:
Daft Paid:
Insp.:
CITY OF EAGAN
3830 Pilot Knob Road
P. O. Box 21199
Eagan, MN 55121
Zoning: i
Owner. . iye
Address:
Site Address: 1365
Plumber. : `.iaen
I gree to newly with the C*r of Iowa
Ordirewcee.
By
Dote of Insp.:
SEWER SERVICE PERIM
PERMIT NO.:
DATE:
No. of Units:
101). 00PA
Conrvedlan aumv: 7 i _ nf)pc
Aoocunt Deposit: 5 - 00pe
Pewit Fee:
Suicimuge:
Misc. Charges:
Total:
Date Pell:
* 18-gh4r0177aL?S?a,ynt ?60o I orn
Ran vest Date Fire No. Rough-m Ins De on
Requ rted?
?Ready Now platy InsDec-
s ?NO for When Ready
cense?E l -,/.at Contractor I hereby request inspection of above
? Owne electrical work installed at:
Street Address- Box or Route No. Crty
1 KJ
e Ion NO, Tow ip Name or No. Range No. County -
Q
Occupant IPRINTI Phone No.
6 ?J
Power S
upp? /Al Address r-
? O?
Elect a C tractor lCompany Namel
ro s License No. Iril.
Mai ng Address (Contractor or Own r Me Ing Ins ilation)
o
` Cli .?
Authonzed azure (
tr or Owner Maki Install wnl Phone n e5r
/'
MI. OTA STATE AID OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT
Gri s-Midway Bld . - Raom N-191 BE ACCEPTED BY THE STATE BOARD
1821 University Ave.. St. Paul. MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone (612129].2111 ENCLOSED.
ncuucal run tLtL, lmuNL marct, nurm
_96 --?--
o r
q ? See instructions for completing this loan on back of Yet low copy.
C 4 O 1 7 7 "X" Below Work Covered by This Request
New Fdtl Type of Building Applmncee Wired Equipment Wired '
Home Range Temporary Service
Duplex Water Heater Lighting Fixtures
Apt. Building Dryet Electric Heating
Commercial Bldg. rnace Silo Unloader
Industrlal Bldg. Air Conditioner BUlk Milk Tank
Farm Omer Peci y 11n, ISPI-I'm
t n. Pau fy the, Oihu,
Compute-In pection Fee Below
N ee Service Entrance Size n Fee Feeders/SUbfeeders A, Fair C
0 to 200 Amps 0 to 30 Amps 0 to 30 Am is
Above 200 Amps 31 to 100 Amps 31 to 100 Amps
Swmynlpg Pool Above 100 Am s; Ahove 100-Amps
Transformers Irrigation Booms Partlal.'Oth
Signs Special Inspection s
TOTAL F
Remarks O J E(
`
Rough-in
' n1e
))-Pu I, the Electr
Inspector, hereby
certify that the ahove
Final D^',
V v/NNF Y'/// inspection has been
made.
This request void 18 months from
CITY OF EAGAN NO
aASn Punt Knnf. Rn.A R/1 R..r ot_. on a---- uu ee?n•
PHONE: 454-8100
BUILDING PERMIT Receipt#
To be used for SF DWG/GAR Est.Value $135,000 Date .TIINF. 18
tg 86
Site Address 1365 TOWERVIEW RD Erect] Occupancy R3
Lot .2 Block 2 Sec/Sub. LEMAY LAKE HILImodel ? Zoning R1
Parcel No Repair ? Type of Const. Vin
. Addition ? No Stories
RIVERVIEW CONST
Name Move ? Length t)z
z
3 Address 9506 RIVERVIEW Demolish ? Depth 53
o City BLMTN Phone 888-1365 Int. lmpr. ?
Install ? Sq. Ft
o Name SAME Approvals Fees
i
$4 Address Assessment Permit $ 520.51
' City Phone Water & Sew Surcharge 67.51
i
F w Name
Address
Z
a City Phone
Police
Fire
Eng.
Planner
Plan Review 260.2
SAC 575.01
Water Conn. 500.01
Water Meter 63 . 51
Road Unit 290. 01
Tr. PI. 156.01
Council -
I hereby acknowledge that l have read this application and state that the Bldg. Off. 6/11/81
information is correct and agree comply with all applicable State of
Minnesota Statutes and City of?gan Ordinances. I APC
Signature of Permittee
A Building Permit is issued to. RIVERVIE CONST
all work shall be done in accordance with all applicable tale of Min
Building Official _
Var. Date CopiesT
T ._f •rG'4
J
on the express condition that
City of Eagan Ordinances.
Cities Digital
ity 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.
a• *
r
520.50-+
67.50 +'
260.25 +
575.00 +
500.00 +
63.50 +
290.00 +
156.00 +
2432.75 *
I v / /
11986 BUILDING PERMIT APPLICATION - CITY OF EAGAN
NOTE: ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN
SINGLE FAMILY DWELLINGS
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS
MULTIPLE DWELLINGS - RESIDENTIAL RENTAL UNITS FOR SALE UNITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITH BLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS
COMMERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL
1 SET OF SPECIFICATIONS AND 1
ENERGY CALCULATIONS,
$2,000 LANDSCAPE BOND
To Be Used For:
Site Address )Z)65
& STRUCTURAL PLANS,
SET OF
/35DDU a
al ation: 1'11- Date:
Lot Block /?.
Parcel/Su
Owner
Address
City/Zip Code
Phone
Contractor
AddreD3
City/Zip Code SS- Y d
Phone eg 2 ./ 3"10 S
Arch./Engr.
Address
City/Zip Code
Phone #
j
Erect Occupancy
Remodel
Repair
Addition
Move
Demolish
Int.Impr.
Install
Zoning IC/
Type of Const ?/
# of Stories
Length ,5
Depth 55
Sq Ft
APPROVALS FEES
Assessments Permit 57d•S?
Water/Sewer Surcharge C„
Police Plan Review
Fire SAC
Engr Water Con n
Planner Water Meter
Council , Road Unit ?lj[}
Bldg Off ti, -11V Treatment P1
APC Parks
Variance Copies
TOTAL 09, q 3 , s -
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS
IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
Zcp?c?jZ= 13?"Zx '` 7t>.A\ b
Zyu3?- ?3?x4?Z zA11D4
3Z-/&/(? e C?; n
CERTIFICATE OF SURVEY
FOR: RIVERVIEW CONST. INC.
B98x' 89
$5.DD N69°44'28"E
x
S
. Drainage and utility esstaent
LOT 2
3
?
\e 3
I
? N N
Scale: 1" = 30'
1P o Denotes Iron tbn.
M
l
? p2x? ° 0 2 x5 c
0 loo. s
16.5
O
o , 52
, 7
I I
PROPOSED S
SOU SE N
Q rn ?O N 2 2
O D)
I u m O
O Y --- 909x5 JA W
to aA?. e d
-
?ID.O o)
)
1?,5 24 G•4,_5
---
9 /
J 9X5 0 ?o9xS \•Oe t
0
\i 0
O O N
5 ?
0 5 r<, ;
nL
yo9-K\= 85.00 Of JV89°44'2WE
W1
?09xI oio8x`?
TOWERVIEW ROAD
LEGAL DESCRIPTION Sanitary Sewer
Invert Elev. = 615)1).'7
Lot 2, Block 2
LEMAY LAKE HILLS x Denotes Proposed Elevation
Dakota County, Minnesota 910.33Top of Foundation
9o 3.ocTop of Basement Floor
MERILA & ASSOCIATES, INC.
ENGINEERS, SURVEYORS, SITE PLANNERS
7216 Boons Avenue North a Suitt E 63
Brooklyn Park, Minnesota 55428
Telsphons? (612) 533-7595
We hereby certify that this is a true and correct representation of a survey of
the boundaries of the above described land and of the location of all buildings,
if any, thereon and all visible encroachments, if any, from or on said land.
As surveyed i s G i Hy day ot• ?AY , 1 9 8 6
/n C/benl Minn. Rag. No. J7-ZS
Job No. 9 / -070 Book - Page
PHILLIPS PLAN 5Li4Vi,;C
R -peso w. i+am s4e411
acWie vaiey, nu+ asiza EXTERIOR ENVELOPE AVERAGE "U" COMPUTATION
OWNER #1 Ll-1116C,
r
SITE ADDRESS
CONTRACTOR 1Zwazv e? Oc»g:T. DATE PHONE
Determine working square footage of each.
1. Total exposed wall area ....... sq. ft. x I
2. Total roof/ceiling area .... 67-b sq. ft. x .021,°
Total exposed wall area above floor = Z r7 5 Z
a. Total wall window area ........................... Z. Z rl,Lc
b. Total door area .. ........................... 3 ?
c. Total sliding glass door area .................... e F53
d. Total fireplace wall area....... ... .........
e. Total wall framing area (average 10%)...:........ Z3
f. Total net wall area above floor ................. 7-1to1.5ze
g. Total rim joist area ........................... -Lq 7
Total exposed foundation area = 1 Q O, 5 Lo
h. Total foundation window area..... .............
1. Toal net foundation area above grade ............ I Q n, Ste
Determine "U" value of each wall segment.
b. 38 X "U" I = 5 a8
c. 88 X "U" rJ - 'LJy.
d.- X lull
e. -L39-,8q X "U" , OgLp = a 3. Oa,
f. ZIt01.SLP x 'lull ,0 q3 = 9a-95
g. Z QZ X "U" , Oy = 11.9-7
h. - X "U"
i. 190. Sto X "u" & O&Z.= 15.63
,37 S
3 .................3.6.
.................Total = i3 J
If item 43 is the same as, or less than item N1, you-have-met the intent
of SBC 6006(c)2.
w
Total exposed roof/ceiling area = I cS Z D
Total gross roof/ceiling area = 18 ZZO
j. Total skylight area ........................
k. Total roof/ceiling framing area ............
1. Total net insulated roof/ceiling area....... IJA3 8.O
Detennine "U" value for each roof/ceiling segment.
X „U.1 _
k. 18 zZ X "u" 10 Z-4 = H 3'7
1. J103b X "U" . OZZ = 36 OH
11
If total of #4 is the same as, or less than #2, you have met the intent of
SBC 6006(c)l.
To utilized the total envelope system method, the values established by the
sum of items #3 and #4 shall not be greater than the sum of items 01 and #2.
1. + 2. _
3. + 4. _
MATERIALS
Exterior Air
Siding Material
Sheathing
Insulation
Sheetrock
Interior Air
Studs
Rim
Conc. Blks.
Therm. Resistance "R"
i?
45
2.0 tr
N5
LA
°,5r7
I, B@
1. 2f?
*
* NOTE: PAYMENT OF FEE AT TIME OF CITY OF EAGA V +
APPLICATION DOES NOT C021STITUTE
w APPROVAL OF PERMIT.
*
APPLICATION FOR PERMIT
* INSPECTION OF SEWER AND/OR WATER
* INSTALLATIONS WILL NOT BE SCHED-
*
SEWER AND/OR WATER CONNECTION ULED UNTIL PERMIT.HAS BEEN
*
* APPROVED.
* *
*
*
*
.... **##*#xxxxxxxxxxx**x#x#xxx**#xxx#xxx
1) PROPERTY ADDRESS:
LEGAL DESCRIPTION:
2)
IF EXISTING STRIXIVRE, DATE OF ORIGINAL BUILDING PERMIT ISSUANCE:
PRESENT ZONING/PROPOSED USE: (Mon Year)
C) M2*1ERCIAL/RETAIL/0FFICE
0 INDUSTRIAL
C1 INSTITUTIONAL/GOVERNMENT
NAME:
ADDRESS:
CITY, STATE, ZIP:
PHONE:
3) NAME: -f - / , For City Use
Plumbers License:
ADDRESS: Active
s
CITY, STATE, ZIP: Expired
Not recorded
PHONE: MASTER LICENSE#a
Sta Initial
4) l.• •• ... u::
NAME:
ADDRESS:
CITY, STATE, ZIP:
PHONE:
CONNECTION TO CITY SEWER CONNECTION TO CITY WATER OTHER
6) v • r PLEASE HOLD APPROVED PERMIT FOR PICK-UP BY ONE OF ABOVE
PLEASE MAIL APPROVED PERMIT TO 1, 2, 3, 4, ABOVE
(Circle one)
7)
ILy R-1 SINGLE FAMILY
R-2 DUPLEX (Two Units)
R-3 TOWNHOUSE (Three + Units) ( Units)
? R-4 APARMOENT/CONDOMINIUM ( Units)
FOR CITY USE ONLY
# ISSUED
PERMIT
,
Pd W/Bldg. Permit FEES:
$ $ /0) .,5 D SEWER PERMIT (INCLUDE SURCHARGE)
$ $ WATER PERMIT (INCLUDE SURCHARGE)
/
$ (c%J7 S $ WATER METER/COPPERHORN/OUTSIDE READER
$ $ WATER TAP (INCLUDE CORPORATION STOP)
$ $ SEWER TAP
$ $ / S CJ? ACCOUNT DEPOSIT - SEWER
$ $ 0 ACCOUNT DEPOSIT - WATER
$ 6-6 0 • C O $ WAC
$ 7 S CJ-Z) $ SAC
$ $ TRUNK WATER ASSESSMENT
$ $ TRUNK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRUNK SEWER
$ $' LATERAL BENEFIT/TRUNK WATER
$ 'D O $ WATER TREATMENT PLANT SURCHARGE
$ $ OTHER:
$ q
/2`/ SL S-D $j? F)Q TOTAL
3 8L G ?Z f
RECEIPT RECEIPT
DOES UTILITY CO NNECTION REQUIRE EXCA VATION IN PUBLIC RIGHT OF WAY?
YES IF YES, THEN A " PERMIT FOR WORK WITHIN PUBLIC
ROADWAY" MUST BE ISSUED BY THE ENGINEERING
NO DIVISION. LIST AS A CONDITION.
SUBJECT TO THE FOLLOWING CONDITIONS:
APPROVED BY:
TITLE:
DATE: ?U d
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41!011
C!tyofEaQall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Use
Permit#:
C ,
Permit Fee: d l Q(..7a
Date Received:
Staff:
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 5:16 ' /2 Site Address: /-544-- T 144'&', uJ Unit #:
Name: 'a v �a- 43c
Address / City / Zip:
Applicant is: Owner
Phone: (S/ -'-t s
Contractor
Description of work: - - v ee•-. d ✓G - y /" l^OvS� 1 a ,4,4./1 672e42,e
Construction Cost:
Multi -Family Building: (Yes / No )
Company: (7i t cr�,�.tiL a1- H�n� Se.✓U($ Contact: k)
J City: f ieVie &Ovi2—
Address: /P6 6 mew 7L eh
State: 04/v Zip: 5S710 f
Phone: 743- Lt93'v22 tf
License #: cip S L/L/S Lead Certificate #: /144-f ' cos3e "
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:
Mechanical Contractor:
Phone:
Phone:
Sewer & Water Contractor: Phone:
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.orq
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.
/L�c‘4
Applicant's Printed Name
x�
Applicant's Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA140898
Date Issued:01/30/2017
Permit Category:ePermit
Site Address: 1365 Towerview Rd
Lot:2 Block: 2 Addition: Lemay Lake Hills
PID:10-44650-02-020
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace
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 -
Evan F Ball
1365 Towerview Rd
Eagan MN 55121
Haley Comfort Systems
122 3rd St W
Hastings MN 55033
(651) 437-0338
Applicant/Permitee: Signature Issued By: Signature