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1961 Timber Wolf Tr N CITY OF EAGAN , . . 3796 Pilot Knob Rood Eogon, Minnesota 55122 Phone: 454-8100 PERMIT No. j_5I2 Date: - ~ Receipt No.: 16 loA ' . . '?'~TL~E?T ~VC?~ `"r~ 1. $ingle I i{ Site Address: Residential 1 }'`f ~WZZQY~S I Lot Block Sub/Sec. Multi Res., Comm./Ind. , -_.'-ah °"t17 Fr Name New/Alter,/Repair. - 1.30Ir, Cbclar Aw. ; Address - Cost of Instollation 5,124 City Phone: Permit fee ' ~jkaTlf CSI ~ - ~ Surcharge NZome ~ ~ n t ; ~ _xrsP~7~ ~C)'t G*.ZC~Pt. ° ° - ~ • . J ~ ~ ,,r, ' t City Phone: Total This Permit is issued on the express condition thot all work sholl be done in occordance with ull opplicable State of Minnesota Statutes ond City of Eogon Ordinances. Building Official r ~ . cinr oF FEAGAN • 3795 Pilet Knob Road Eagas, MN 351 12 N! 5440 - . • • PHONEs 454-8100 ~ BUILDING PERMIT , Receiat Te be uad for Est. Value Date - 19 Site /lddress i~c?-,~~- Erett ? Octupancy Lot Blxk 5ec/Sub. Alter p Zoning Parcel # Repalr ? Firo Zone Enlorge p Type of Const. W Name Move ? # Stories 9 z Address Demolish p Front ft. Cit Phone Grode p Depth ft. ~ Name APProvob Fees ,O u~ Addreu Assessment Permit ~ Ci Phone Woter & Sew. Surcharge Police Plan check ~W Na^e Fire SAC Addreu Eng. Water Conn. <W Ci Phone Planner Woter Meter Counci I I hereby ocknowledge that I hove recd tfiis applicotion ond state that gldg. Off. the information is correct cnd ogree to comply with all applicable AP~ Totol State of Minnesotn Stotutes and City of Eogon Ordinonces. Slgnoture of Permittee A Building Permit is issued to: ' on the express condition Hwt oll work sholl be done in accordance with all opplioable Stote of Minnesota Statutes and City of Eagan Ordinances. Building Official . ' Mewlt # Dab isreN hrrlffM Plumbing Ic'lr f f~s' c~- • Mechanical INSPECTIONS DATE INSP. Rouph-In Firql Footings Date Insp. Date Irnp. Foundation Plumbing / - Framefins. j` Mechanicol 4f- A Finol Sc Remarks: CITY OF EAGAN ~ , 9795 Pilot Knob Rood ` Eagan, Aounmeme ssiu Phona: 454-9100 . , r PERMIT No. r Dote: Receipt No.: Single I Site Address: ' . ;~1_?'lbr'r4.; •l F „T'1 . Residentinl ~Y Lot - • Blxk 1 Sub/Sec. C,aGOr,ti'1%,nr?S Multi Res., Comm./lnd. I Name ?'?S'tI' New//11ter./Repoir . ~ Address Cost of Instollation ~~~le t%~,1I~~Y ?.~1, nr City Phor~e: Permit Fee '::e tiard;,Ta-~ Stnr? ,n i Name Surcharge ° a Address 315 3Xd StrGBt 0 City Phone: Totol This Permit is issued on the express condition that oll work sholl be done in accardonce with all opplicable State of Minnesota Statutes and Ciry of Eogon Ordinances. Building Officiol CITY OF EAGAN Remarks Addition _ Nleadovland lft Addition Lot 21 aik 1 Parcel 10 48050 021 01 Ow/ner Street 1961 N. T3.lllbat Nolf Trail State Ea4an, MN 55122 Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. STREET RESTOR. ij( 1589.99 C005636 10 15 80 GRADING SAN SEW TRUNK 70 77.95 3.12 25 ' S * SEWER LATERAL 31565 $ 3 6-17-80 WATERMAIN * WATEF LATERAL WATER AREA 7 6.35 15 rnn= 1O STORM SEw TRK 4Qf 1971 282.92 14.15 20 * STORM SEW LAT 19 * CURB & GUTTEF SIDEWALK STREET LIGHT WATER CONN. 970-00 it BUILDING PER. 5440 SAC PARK SEWER SERVICE PERMIT CITY OF EAQAN PERMIT NO.: , •95 piiot Knob Road DATE: CO9°°' µ1~1 55122 No. of Units: ~ Zoning: . Owner. Address: . : ~ rt,L?~ ,.r`.~- - Site Address:~ r , ~ •~c 1.1_.;~ ~ . •.•irP(+Y:1 'Ct}~I:- ~•~~;,~t~~'? . Plumber. I agree tu wmPh wkh the City of Ea9on Connection Chorge: pccount Deposit: , Ordinancas. Permit Fee: Surcharge: - M;u, Charges: By - Total: Date of Insp.: Date Paid: I nsp.:- WATER SERVICE PERMIT CITY OF EAGAN PERMIT NO.: ,1• 1795 Piiot Knob Road DATE: 'wgan, MN 55122 _r Na, af Units: _ Zoning: - pwner: Address: 5'te Addressf ~ f+•-Lt rn D Cz 6G: ~ nt:. Plumber. Connection Char9e. ?vleter No.: _ Account Deposit: Size: Permit Fee: - - • Reader No.: Surcharge: witi+ f1~e CitY of Eagoe I agree to eomplY Miu. CFarges: prdlnanees. Total: Date Pald: By Insp.: Date of Insp•' ' CTPY OF EAGAN 5aL~o Include 2 sets of plans, 1 site plan w/elevations & BUILDING PERNIIT APPLf TION 1 set of energy calculations. °f' 1~3, v" To He Used For ri/.LU/ ~E/ orn ~ valuation ~ Date 9- Z o- 7 9 Site Pddress: OFFICE USE ONI,Y Lot ~ slocx I sec./sub. NWrY Srect OccupancY Ji.3 Parcel 0~l-D-Isr, ~,j zoning ~ ~/R0~l~ ~ Repair Fire Zone Oaner: __~65 ep i~ r- ~~e of Const. 7i Move # Stories Pddress: c IS A-,ie.so Deamlish Front 'S~!3 ft. City/Zip Code: 8-,. Vd,l~.c.a I'ko-7 ~ Grade Depth -5C5- ft. Phone t{ 3-- - 0 o'Z, S~ ~ z 1 APP%7VAIB FEES contracrAr: J- se,. 4- n, assessaents Fermit / a. 3 T- Water/Sewer Surcharge ;!2 Pddr2SS: POliCe Plan Ch2Ck (n/ ~-z= City/2ip Code: Fire SAC Sati ~ iq, Wates Conn. ~'~6 °---°Phone g Planner Water Meter ~ Arch./~g.: Council Road Unit Bldg. Off. Address: APC City/Zip Code: y~ Phone TOTP'T''~%T.~~- - s This~r'eq voiM months from Date of this Request 10-10-1979 13736 I, a&10 Licensed Electrical Contractor 0 Owner, do hereby request inspection of the above electri- cal wiring installed at: SVeet Address or Route No. 1961 North Timber~e-~Trail City an Section Township Range County Dakota Which is occupied by Joe Millex Construction (Name of OcCUpent) ls a roughin inspection required on this job? No ? Yesilc Ready Now ? Will Call tbc. PowerSupplier naknta t'.ty. Address Farm;ng+nn E?ectricalContractor O.B. Thompson Electric Co. ContractoPsLicenseNoAIB62 (COmoany Name) Mailing Address 12201 Nltka Blvd., Mtka i55343 (Electrical Contractbr or Owner Making Tnis Installatlon)'~~- %~i/~_:~it.:%?.i;i C~i Authorized Signature + _ Phone Nor- (Electrlcal Contra<tor or Ownar Makinq This Installatlon) n .p O~~D ~0~~ This inspection reqpest will nPt he accepted by tha W ~ o State Board unless raper ins ecUon he is endosed. Minnesota State Board of Electricity Univer'sity Ave., St. Paul, Minn. 55104-PhQne 645•7703 , REQUEST.EOR ELECTRICAL INSPECTION C CK BELOW WO~C COVERED BY THIS REQUEST S Type ot Building New Add. Rep. Check Appliances W'ved For Check Equipment Wited Foc Home IN ? D Range 11 Tempoiary Wiring ? Duplex ? ? ? Water Reater ? Lighting Fixtuies EF Apt. Bldg. Dryei ? Electric Heating 0 CommereialBldg. 011 ? Fumace OK2•00 SiloUnloader El Industrial9ldg. Au Conditionec ? Hulk Milk Tank ~ List.^ List ) Farm ? ? ? ~t p } Othei ? ? ? H8re13~ ' HeherSl COMPUTE INSPECTION FEE I,OW. . Service En[cance Size: # er`s&Subfceders: x Fee C'vcuita: # Fce 0 to 100 Am s.1 O(T 0 to 30 Am eres 0 s 1 2• 101 to 200 Amps. 31 to 100 Amperes res Above 200_Amps. Above 100 Amps. ps. Transtormecs Remote Control Circ. e Signs Special Ins ection Remazks - 4j;aCnpsI les 0.00 n has bee~~ d~ J~~ ~ I, the Electrical Inspector, hereby cr hatio (Rough-in) '~c6LJ Date (Final) Date~ d This request void 18 months from ciTr oF Er?caN 9795 iilot IRheb RocB Eagan, MN 55124 N4 5 4 4 0 . - • PHONEs 434-8100 BUILDING PERMIT APPLICATION $439000. Receipt To be med for SF Dw1g. Est. Val Date 19~2 Site Address- ' 1961 N. Timbe Y• Erect ? xOaupnncy R3 Lor ZL aixk 1 Sec/5ub. Meadowlands Airer ? Zoning Rl pa~~ LO 48050 021 01 Repair ? Fire Zone 3 Enlarge ? Type of Const. V c Name Joseph M Mi11Er move ? # Stories z Add~ess 13015 Cedar Ave. So. pe,,,oi;sh ? Front 43 n. CI P e a eyPhone Grade ? Dapth 45 ft. ° Name $a, Approvalt Fees 0 ot Address Assessment Permit 123.00 Water & Sew. Surcharge Z 1. SO « PhO^e 61. 50 Police Plan check Om w Name Fire SAC 525.00 _g Address Eng. Water Conn. 270.00 Q,ZU Ci phme Planner WaterMeter 60.00 CD,,,,c;i Rd Unit 75.00 I hereby acknowledge that I have read this opplicotion nnd stote that Bidg. Off. the infortnction is correct and agree to comply with alI aOPlicable 1136.~0 Stote of Minnewta Stotutes and City of Eagon Ordirwnces. APC Total Signature of Permittee A Building Permit is issued to:. `~TOSe M~18 C on the express conditlon that all work shall be done in acwrdanc i h applic6Te te-of-Minnes ta mtutes and C(ry of Eagan OrcJinances. Building Offlclol - - ~ 30,-(k) 2005 RESIDENTIAL MECHANICAL PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 Please complete for: single family dwellings &[ownhomes/condos when permits are required for each unit Date Site Address lq,~ ~-Tl rG~ U--ck'E" -WA F Unit # PropeHy Owner(EY-"n`CL 4 ka STrg~~D Telephone # (GEDk )~~-Lntc~.~ Contractor Wohlers Southside Htg. & Air, Inc.~ j 6950 W. 146`" St., #106 ' Street Address I Apple Valley, MN 55124 City I (952) 431-7099 State ~ Telephone # ( ) --~p~ Bond#: 5L4 r7 9 g ~7 Expires: O~ The Applicant is _ Owner Contractor _ Other Add-on or alteration to ezisting dwelling unit $ 30.00 3J-. fumace _Additional k'Replacement ' air exchanger airconditioner _New _Replacement other State Surcharge $ .50 Total $ ip ~ [ hereby apply for a Residential 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, 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. y - ApplicanYs Printed Name Applicant's Signature MAR 1 1 z005 I II L J ~'Y 2005 COMMERCIAL MECHAlvICAL PERMIT APPLICATION City OfEagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 Please complete for: commercial/indusvial buildings mulci-famity buildings when separate permits are not required for each dwelling unit Date Site Street Address Unit # Tenanf Name (ifapplicable) Previous Tenant Name Property Owner Telephone # ( ) Contractor Street Address City State Zip Telephone # ( ) Bond Expires: The Applicant is _ Owner _ Contractor _ Other Work 1'ype New Construction _ Underground Tank _ Install _Remove *"see below _ fnterior Improvement _ Install Piping _Processed _Gas Nature of Work: " When insfalling/removing underground tank, call for inspection by Fire Marshal attd Plumbing lnspector PeI'RII[ T'C¢S: $70.50 Underground tank ins[slla[ion/removal - 550.50 Mirtimum (includes State Sulcharge) or Contract Value $ x 1% Permit Fee • If oe rmit fee is $1,000 or less, add $.50 $ State Surcharge If ep rmit fee is over $1,000, add $.50 for every $1,000 eP rmit fee $ Total Fee I 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 1 understand this is not a permit, but only an application for a permit, and work is not to start without a permiY, that the work will be in accordance with the approved plan in the case of work which requires z review and approval of plans. ApplicanPs Printed Name Applicant's Signature Approved By: , Inspector Date: cPAT GEAGAN March 2, 2005 Mayor INDEPENDENT CLAIMS ADMINISTRATOR rECCr cnai.soN MASONITE HARDBOARD SIDING SETTLEMENT CYNDEE FIELDS P O BOX 952 MINNEAPOLIS MN 55440-0952 MIKE MAGUIRE MEGTILLEY ATTENTION: BELINDA CouncifMem6er: RE: 1943 TIMBER WOLF TR S 1961 TIMBER WOLF TR S THOMAS HEDGES Dear Belinda: Ciry Adminiserator Please be advised that the following buildings received final occupancy inspections as follows: • 1943 Timber Wolf Tr S Final inspection 12/13/79 Municipal Cen[er: • 1961 Timber Wolf Tr N Final inspection 1 I/20/79 3830 Pilot Knob Road When these buildings were constructed, it was not a requisite that cities issue a Certificate of Eagan, MN 55122-1897 Occupancy when performing a final building inspection. Therefore, there are no Certificates on Phone: 651.675.5000 file for these properties. Fax: 651.675.5012 This information is correct to the best of my lmowledge. If you have any questions regarding the TDD: 651.454.8535 above, please do not hesitate to contact me at 651-675-5671. Sincerely, Maintenance Faciliry: ` ~ L 3501 Coachman Poinc ~ Jan` ice D. Severson Eagan, Mr7 55122 Office Supervisor Phone: 651.675.5300 Fzc: 651.675.5360 cc: Dale Schoeppner, Chief Building Official TDD: 651.454.8535 www.cityofeagan.com THE LONE OAKTREE The symbol of s[rength and growth in our communiry , . . . . _ _ . PI-GT PLFiN Scaie res reet z~ h e r+ i'i.. ~H ~.f3v7~a1'• y'c-'_ ~ - - E . I ~ p t: - ~ ~ ~ - t L S.F'f ef -77 ~ r~si~nTg t ; , r7,_ ~ _ , , a - - ~ MM LI.T ' %MT r [7- l'_ H~-4 r;=t ± ~ - ~ r L` ~ ~ - t-;_ ~ , - t. :~:CStr?T ~ ~ : ; ; . , fou uoA~,o?~~# -r ~rrsS I 1 ' . . . . . n~. . 1 t Dy'u~1Pe s ! l^Qc ( PLCT PLf11l1 Sc:de -,;Iqmm es ;cet 1117 , z~ _S p ri flc ,u . _ .~vr/d~• T`e ~ ~ - : , _ - : r ' 7~-j 1-7 } , -1 t , . ~ _ i ~ - - - - ~ v+ c ~ - - ~ - , , ' l p#sk- I ~ _ f ~ ' - wvb%h -aJC, . , + - - ; _ . ~ . , , ~ - - ~ ~ - • ~ Egresc GSn,T = t i ~ ~ , ~ ( . . i . . . . 4 : ~ .WAtL.- 7 ! L ~ ` u tSE .1777 _1 , i - _ - T j ~FT ' ~ ~ - E ~;-I s -~B1Fo , .Onw.~-~- - - - r i - ~ ' - fouuQ?i G 1 ...f,~ ~l ni..e•~i :.I tC. t,~, :('.i i.:i n:~n ~ ~i . r'. 'i ~ ~ . ~ i ~ . . CASH RECEIPT _ ~ - CITY OF EAGAN 3795 PILOT KNOB ROAD EAGAN, MINNESOTA 55122 DATE 19 R6C61VED FROM ~ AMQUNT $ I ~ & COLLARS ~oo E]CASH E] CHECK V ~ FUND COOE AMOUNT i I ~ ` , ' , i 7/` ~ _ - . Thank You ~ 1r Y BY / White-Payers Copy Yellow-Posting Copy ~ • - Pink-File Copy Use BLUE or BLACK Ink r I For Office Use ? I Permit City of Ea 60 Permit Fee. 3830 Pilot Knob Road I I Eagan MN 55122 Date Received: Phone: (651) 675-5675 I 96- Fax: (651) 675-5694 I Staff: 1 I I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Unit Name: ~e I Phone: L~I' C- SS7~] Resident/ Owner Address/ City/Zip: AL I MOL s~12 Applicant is: _X_ Owner Contractor r Type of Work Description of work: 1*1 L V T Construction Cost: _ V y Multi-Family Building: (Yes / No Company: Contact: Contractor Address: City: State: Zip: Phone: License 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 kNo 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 maybe 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.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. Exterior work authorized by a building permit issued in accordance with the Minnes to state Building Code must be completed within 180 days of permit issuance. x t.," ce, t) x Applicant's Printed Name App ' nt's Si ture Page 1 of 3 PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA148263 Date Issued:03/16/2018 Permit Category:ePermit Site Address: 1961 Timber Wolf Tr N Lot:021 Block: 1 Addition: Meadowlands 1st PID:10-48050-01-021 Use: Description: Sub Type:Residential Work Type:Replace Description:Water Heater Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener). Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). 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 - Firstkey Homes 1961 Timber Wolf Tr N Eagan MN 55122--222 MNP Mechanical LLC 452 8th Ave SW Lonsdale MN 55046 (952) 292-9238 Applicant/Permitee: Signature Issued By: Signature For Office Use ti,% E AG A N o •• ,®, :::: /OUG� Date Received: 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 (651)675-5675 I TDD:(651)454-8535 I FAX:(651)675-5694 Staff: buildinginspections(a�cityofeagan.com L 2018 MECHANICAL PERMIT APPLICATION ❑ Please submit two(2)sets of planswith all commercial applications. Date: Site Address: / 9i T// 4/ t'1 1"'''l /.f/ a/✓ Tenant: 111 / Suite#: e . t/Ow Name: /5 7�. i/. /�12/'. Phone: 5 : Address I City I Zip: Name: �h' ',./7,,./.- JG '.. G' �l/<7!(4 1 U�/� 'License#: r > • fy / / i Address: > /C) � SJL t',- City: 9'C1/�l'1J/ �7, �'/-7 +Contractor State: A/A/ Zip: .5-5--61,1:7111 C:'/�� Phone: `;.^di/.' r' 5e7 v <w Contact: +Jd Jo'�'7 (stew Email:ji; $6•1'74—eD tec-7�i,01,(G`i" New X Replacement Additional Alteration Demolition Type of Work Description of work:.,L✓/ 547// ''‘'''''w /"v„11.4,41,7", `' /¢�C v NOTE:`Roof mounted m ound moiunted m ',, . IYeq t',' - ° °r °s creened y C , Code.; Please C ontact Mechanical kt101;‘,...°'®y or ink ff <, nsening methods RESIDENTIAL COMMERCIAL X Furnace New Construction Interior Improvement /� Air Conditioner Install Piping Processed Permit'Type Air Exchanger Gas Exterior HVAC Unit Heat Pump Under/Above ground Tank ( Install/_Remove) —Other RESIDENTIAL FEES $60.00 Minimum Add or alteration to an existing unit, includes State Surcharge $100.00 Residential New, includes State Surcharge =$ TOTAL FEE COMMERCIAL FEES $60.00 Permit Fee Minimum Contract Value$ x.01 $75.00 Underground tank installation/removal, includes State Surcharge =$ Permit Fee Surcharge=Contract Value x$0.0005 =$ Surcharge If the project valuation is over$1 million, please call for Surcharge =$ TOTAL FEE You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's website at www.citvofeagan.com/subscribe. 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 Name licant's Signature FOR OFFICE USE . Required Inspections: Rev By '� w y� {z 5' g round Rough in "Air Te Gas S e Test xrt In'floor Heat .• Trial ,,HVAC Scr ru Under r� � PERMIT City of Eagan Permit Type:Building Permit Number:EA179475 Date Issued:10/06/2022 Permit Category:ePermit Site Address: 1961 Timber Wolf Tr N Lot:021 Block: 1 Addition: Meadowlands 1st PID:10-48050-01-021 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: This permit shall be null and void if work does not start within 180 days of issuance, or if work is suspended for 180 days or more after started. 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 - Andrew Suel 1961 Timber Wolf Trl N Eagan MN 55122 (920) 393-0844 Universal Windows Direct Twin Cities 150 88th St W #205 Bloomington MN 55420 (612) 866-2888 Applicant/Permitee: Signature Issued By: Signature