4150 Beaver Dam Rd
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101 6'7 IZU,6t C,"We BLUE or BLACK Ink
I For Office Use
Permit GQ
n o n
J_`6- City Ol EQ
Qll Il I S
I Permit Fee:
3830 Pilot Knob Road I I
Eagan MN 55122 I I
I Date Received: I
Phone: (651) 675-5675 I
Fax: (651) 675-5694 I Staff: I
L-----------------
2013 COMMERCIAL BUILDING PERMIT APPLICATION - 12 UY1 t tS
Date: '1 d17 Site Address: yv
gvCr are.
Tenant Name: Coe ftj 0,1 (;,.,1 ko+nt$(Tenant is: New / i`-, Existing) Suite
Former Tenant:
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Name: D;MtN C.or%ho.,s ;L \j%kk&s ot^j !~gCL,& "S Phone: AS*A- 4 3 a- 817 9
Property Owner Address/ City /Zip: ?b D42X N>3 et ho\)V% (of?
Applicant is: Owner Contractor
Description ofwork~eac- Oicr Qnc- (,oo~ a!, C1~rar 5 .vh Ct ^'C`
Type of Work
Construction Cost: b~~q
Name: O T License \J .C~ 1 t et
a a Address: ~Aojv lee, o•vL City: q 10!5C_ 0jV%A-
Contractor
State: M ~J Zip: ';J5'0(~sn Phone: !Tcs-l - 21 ;L` ~ 9 (as
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? Contact: LG-► Email: ~f j kd V ek( e, 6
Name: Registration
Architect/Engineer Address: City:
State: Zip: Phone:
a 2
Contact Person: Email:
Licensed plumber installing new sewer/water service: _Phone _ _
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to y
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.got)herstateonecall.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.
x Lc~j_ I o V x - r}nu. -
Applicant's Printed N e Applicant's Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA131404
Date Issued:06/17/2015
Permit Category:ePermit
Site Address: 4150 Beaver Dam Rd
Lot:011 Block: 04 Addition: Diffley Commons 2nd
PID:10-20451-04-011
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 -
Linda J Baker
4150 Beaver Dam Rd
Eagan MN 55122
(651) 308-1306
Pella Northland
15300 25th Ave N #100
Plymouth MN 55447
(763) 355-1300
Applicant/Permitee: Signature Issued By: Signature