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2015-00177CITY OF MONTICELLO 505 WALNUT STREET MONTICELLO, MN 55362- 763) 295-3060 FAX (763) 295-4404 ADDRESS 9320 CEDAR ST S PIN 155169001010 LEGAL DESC : MONTICELLO BUSINESS CTR 3RD ADDN LOT 001 BLOCK 001 PERMIT TYPE BUILDING PROPERTY TYPE COMMERCIAL CONSTRUCTION TYPE TEMPORARY VALUATION : $ 500.00 NOTE: BUILD A TEMPORARY STRUCTURE PER DESIGN. APPLICANT WAL-MART REAL EST BUSINESS TR 1301 LOTH ST SE PROP TAX DEPT #8013 AR 72716-0555 OWNER WAL-MART REAL EST BUSINESS TR 1301 LOTH ST SE PROP TAX DEPT #8013 AR 72716-0555 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 iiiiiiiiiiiiiiiiiiiiiillillillillillillilliiim 2015-00177* DATE ISSUED: 04/15/2015 BUILDING PERMIT FEE STATE SURCHARGE, BLDG VAL TOTAL Payment(s) CASH 24.91 0.25 25.16 25.16 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF ----_— -- Monticello -__ _ _ _ PERMIT # u Al BUILDING SAFETY I 505 WALNUT STREET, SUITE I N ICELLO, MN 55362 • I . City Hall (763) 295-2711 u ., s) ;295-306a iz (6) 295-a4©4 sT' ul APPLICA O Please Print - INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED. SITE ADDRESS: 971-XI 5rV A14 'rf -ZONED LEGAL: Lot Block Plat Property Owner Name: Phone: Address: Q2t32-0 Cc-_sDkA, S^ City: State: d1hI/ Zip: Contractor Name: i"134< State License #: Address: Eng./Architect Name: N Address: Plumber Name: At Jac_ Address: Mechanical Name: (k Address: Tvve of Fork New Addition Alteration Repair Move Other City: City: City: City: Tvue of Construction Single Family Duplex Multi -Family Commercial Industrial La'_ Other Phone: State: Zip: Phone: State: Zip: Phone: State: Zip: Phone: State: Zip: Building Information Use of building of stories Floor area sq. ft. Estimated value U of construction $ QPa . Description of work: r ` ` c 1 A, 1a ` P., , S Cv"V c t` l.&% .l ®s.l C,J 1:c3 or- d we sir v S - - 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 Rate 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 publicproperty including but not limited to curb, sidewalk, public utilities and signs will be repaired at my expense. ACK FORSEEBUMECHANICALNFG O. ANDApplicantSignature Application Date APPLICANT. Please show.fbaures that are applicable. Fire Suppression : (f applicable) PlumbinP: (f applicable) Mechanical: (if applicable) No. Fixture Tvpe No. Fixture Tvue No. Fixture Tyne Sprinkler Heads Water Closet (toilet) Furnace Other/Special FSDevice 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 Tvpe Drinking Fountain Gas Opening w/o Fixture Floor Drain of Devices Slop Sink Other Outside Faucet TOTAL TOTAL Future Owner Information• Tree Ordinance Handout Yes No Other Handouts Yes No Name: Address: City: ADDITIONAL INFORMATION: Valuation: State: Zip: Construction Type: Occupancy Group: Phone #: Division: Square Footage: of Stories: of Residential Units: Maximum Occupancy: Fire Sprinklers: Yes No Off -Street Parking Covered: Off -Street Parking Uncovered: Building Offllcial7AM-o ml&v 3 MILS BPT: / / Vv sweM Ir 4c) 14 b c A5.3j J14, 14, Jul Sincerely, Krista Sand C, Asset Protection Manager Cell 7.6.3.999.1961 Office 763.295.9800 Fax .7.6.3.295.9.809 kisand.s03624.us@,wal-mart.com Walmart 3624 9320-Cedar Street Monticello, W55362 Walmart * Save money. Live better. Please consider the environment before printing this e-mail Walmart Confidential APPRICIVE-D, PUE COPY H EM WF! 70, t;ODF. j Cj -I-C) jfjF,9C-CTj0N Date j5s,ctea