2007-00738CITY OF MONTICELLO
505 WALNUT STREET
MONTICELLO, MN 55362-
763) 295-3UbU YAX: (763) 295-4404
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2007-00738*
DATE ISSUED: 09/05/2007
ADDRESS 102 KENNETH LN
PIN 155021002460
LEGAL DESC RITZE MANOR
LOT 046 BLOCK 002
PERMIT TYPE PLUMBING
PROPERTY TYPE SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE LAWN SPRINKLER
NOTE: NOT TO BE LOCATED IN PUBLIC RIGHT OF WAY
BACK FLOW PREVENTOR AND RAIN SENSOR ARE REQUIRED
NUMBER OF PLUMBING FIXTURES L
APPLICANT PLUMBING BASE FEE, RESI
PLUMBING FIXTURES
45.00
9.00
DUNNING,WALTER E SR&NANCY C
STATE SURCHARGE, PLBG FIX 0.50
102 KENNETH LN
MONTICELLO, MN 55362 TOTAL 54.50
Payment(s)
CHECK 7335 54.50
OWNER
DUNNING,WALTER E SR&NANCY C
102 KENNETH LN
MONTICELLO, MN 55362
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
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
MONTICELLO
DEVELOPMENT SERVICES
BUILDING INSPECTIONS
505 WALNUT STREET, SUITE 1
MONTICELLO, MN 55362
City Hall (763) 295-2711
PERMIT #%
PID #
Building Inspections (763) 295-3060 Fax (763) 295-4404
Please Print -INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED.
SITE ADDRESS: U 2 rN C`1{ "9 -w ZONED
LEGAL: Lot Block Plat
Property Owner N me: Phone: -2i,'-, - -:52 qS
Address: V i t (0,C cc City: M State: Zip. ^ 7(
b-
ic)z i Fc c z CI _0(Z- _4(/
Contractor Name: Phone:
State License #:
Address: City: State: Zip:
Eng./Architect Name: Phone:
Address: City: State: Zip:
Plumber Name: Phone:
Address: City: State: Zip:
Mechanical Name: Phone:
Address: City: State: Zip:
Type of Work Type of Construction Building, Information
New Single Family Use of building
Addition Duplex of stories
Alteration Multi -Family Floor area sq. ft.
Repair Commercial Estimated value
Move Industrial of construction $
Other Residential Garage Is this a "Master Plan" per MN Rule
Other 1300.0160 Subp.6.9 Yes No
Description of work:
I hereby apply for a permit for construction as described and acknowledge that the information I have provided above is complete and accurate. 1
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.
Applicant Signature
SEE BACK FOR PLUMBING
AND MECHANICAL INFO.
Application Date
APPLICANT: Please show.fixtitres tliat are aDDlicable.
Fire Suppression : (if applicable) Plumbin-,: (if applicable) lYleclzrrnical: (if applicable)
No. Fixture Type No. Fixture Tvoe No. Fixture Tvpe
Sprinkler Heads Water Closet (toilet) Furnace
Other /Special FS Device Bathtub Gas iYleter
Lavatory (mash basin)
Shover
ICitchezz Sink
Dishwasher
Laundry Tub
Rang, e Hood
Gas Range
boater Heater
Air Conditioning
Mech. Fireplace
Fire Alarm: (f applicable) Clothes Washer Bathroom(s) ExIzaust Fan
Water Heater Air Exchanger
No. Fixture Tyne Urinal Dryer
Drinking Fountain Gas Opening v/o Fi_eture ,
of Devices
Floor Drain
Other slop Slop sink`
TOTAL TOTAL
9 Per Fixture) 9 Per Fixture)
r r,r,LIJ:
Bldg. Permit
Plan Review
State Surcharge
Bldg. Total
Plmg. Permit
Fixtures
Surcharge
Plmg. Total
Mech. Permit
Fixtures
Surcharge
Mech. Total
Sewer Access
Water Access
Water Meter
vleter Sales Tax
IVIeter Total
Sew & Water Permit
Trunk Water
Trunk Sanitary Sewer
Trunk Storm Sewer
Lift Station
AL FEES:
Tree Ordinance Handout Yes No
Other Handouts Yes No
ADDITIONAL INFORMATION:
Valuation:
Construction Type:
Occupancy Group:
Division:
Square Footage:
of Stories:
of Residential Units:
Maximum Occupancy:
Fire Sprinklers: Yes No
Off -Street Parking Covered:
Off -Street Parking Uncovered:
Building Official
BPT: / j