2017-00720CITY OF MONTICELLO
505 WALNUT STREET
MONTICELLO, MN 55362-
763) 295-3060 FAX: (763) 295-4404
ADDRESS 9091 GOLDEN POND LN
PIN 155235003210
LEGAL DESC SUNSET PONDS 3RD ADDN
LOT 021 BLOCK 003
PERMIT TYPE PLUMBING
PROPERTY TYPE SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE NEW CONSTRUCTION
NUMBER OF PLUMBING FIXTURES
APPLICANT
KAB
20725 196 TH AVE
BIG LAKE, MN 55309-
763) 219-3599
OWNER
R HOME LLC
3495 COON RAPIDS BLVD
ANOKA, MN 55303-
13
AGREEMENT AND SWORN STATEMENT
I agree that the work will be conducted in conformance with
the ordinances of the City of Monticello and with the
Minnesota State Building Code. I understand that the work
will be in accordance with the plan that has been approved by
the Building Official. I agree that any damage caused to
public property including but not limited to curb, sidewalk,
public utilities and signs will be repaired at my expense.
Applicant
Date
Bldg Official Date
mulmmuffiflum
2 0 1 7— 0 0 7 2 0*
DATE ISSUED: 10/03/2017
Permit #: 2017-00720
PLUMBING BASE FEE, RESI 45.00
PLUMBING FIXTURES 117.00
STATE SURCHARGE, PLBG FIX 1.00
TOTAL 163.00
Payment(s)
CREDIT CARD 6396 163.00
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF
Montiaello
BUILDING SAFETY
PERMIT # 1 ( - T
505 WALNUT STREET, SUITE 1 MONTICELLO, MN 55362
City Hall (763) 295-2711 Building Inspections (763) 295-3060 Fax (763) 295-4404
BUILDING PERMIT APPLICATION
Please Print - INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED.
SITE ADDRESS: 9/ (,,e1e31jvt A®kiL ZONED LEGAL:
Lot Block Plat Property
Owner Name: Phone: Address:
City: State: Zip: Contractor
Name- 7 %f0 - Phone: 7b Z l State
License #: 7=1 <g- & `7 CO Address:
p)-7 2 5- lqk 0' City: ®ri A! State: Zip: 55'3wq Eng./
Architect Name: Address:
Plumber
Name: Address:
Mechanical
Name: Address:
Tvne
of Work New
Addition
Alteration
Repair
Move
Other
Phone:
City:
State: Zip: Phone:
City:
State: Zip: Phone:
City:
State: Zip: T,
viDe of Construction Building Information Single
Family Use of building Duplex
of stories Multi -
Family Floor area sq. ft. Commercial
Estimated value Industrial
of construction S Other
Descrip4tio/
hofwork: 6 C
IlVcA
A I
hereby apply for a permit for construction as described and acknowledge that the information I have provided above is complete and accurate. I agree
that the work will be conducted in conformance with the ordinances of the City of Monticello and with the Laws of the State of Minnesota; and
that I understand that this application is not a permit and that the work is not to start without a permit. I further understand that the work will be
in accordance with the plan that has been approved by the Building Official. I agree that any damage caused to public property including but not
limited to curb, sidewalk, public utilities and signs will be repaired at my expense. SEE
BACK FOR PLUMBING AND
MECHANICAL INFO. Applicant
Signature ApplicationlDate /
APPLICANT. • Please show fixtures that are applicable.
Fire Suppression : (if applicable) Plumbine: (if applicable) Mechanical. (if applicable)
No. Fixture Tvoe No. Fixture Tvne No. Fixture Tvue
Sprinkler Heads Water Closet (toilet) Furnace
Other / Special FS Device Bathtub Gas Meter
Lavatory (wash basin) Range Hood
Shower Gas Range
Kitchen Sink Water Heater
Dishwasher Air Conditioning
Laundry Tub Mech. Fireplace
Clothes Washer Bathroom(s) Exhaust Fan
Fire Alarm: (if applicable) Water Heater Air Exchanger
Urinal Dryer
No. Fixture Tvue Drinking Fountain Gas Opening w/o Fixture
Floor Drain
ofDevices Slop Sink
Other G Outside Faucet
Name:
Address:
City:
State:
Phone #:
Future Owner Information:
TOTAL
FOR CITY USE ONLY
Tree Ordinance Handout Yes No
Other Handouts Yes No
ADDITIONAL INFORMATION:
Zip:
Valuation:
Construction Type:
Occupancy Group:
Division:
Square Footage:
of Stories:
of Residential Units:
Maximum Occupancy:
Fire Sprinklers: Yes
Off -Street Parking Covered:
Off -Street Parking Covered
Building Official
BPT:
No