2016-00499CITY OF MONTICELLO
505 WALNUT STREET
MONTICELLO, MN 55362-
763) 295-3060 FAX: (763) 295-4404
ADDRESS 102 KENNETH LN
PIN 155021002460
LEGAL DESC RITZE MANOR
LOT 046 BLOCK 002
PERMIT TYPE MECHANICAL & PLUMBING
PROPERTY TYPE SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE FURNACE & A/C
2 0 1 6— 0 0 4 9 9*
DATE ISSUED: 08/10/2016
NOTE: REPLACE FURNACE, A/C, WATER HEATER & WATER SOFTNER
NUMBER OF MECHANICAL FIXTURES 2 NUMBER OF PLUMBING FIXTURES
APPLICANT
QUIST, SUSIE
102 KENNETH LN
MONTICELLO, MN 55362-
OWNER
QUIST, SUSIE
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
MECHANICAL BASE FEE, RESI
MECHANICAL FIXTURES
STATE SURCHARGE, MECH FIX
PLUMBING BASE FEE, RESI
PLUMBING FIXTURES
STATE SURCHARGE, PLBG FIX
TOTAL
Payment(s)
CHECK 6427
2
45.00
18.00
1.00
45.00
18.00
1.00
128.00
128.00
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
It CITYGOPQemtNo. Ac
M ntkello Date UIIDINC $
AFFTY RESIDENTIAL
BUILDING PERMIT ADDITION /
ALTERATION / REMODEL SITE
ADDRESS 1C2
Kenneth Lane LEGAL
DESCRIPTION LOT
BLOCK PI.D. NUMBER PLAT
OWNER (
Name) (Address) (Tel. No.) Susie
Quist 102 Kenneth Lane Monticello, MN 55362 (612) 412-6231 CONTRACTOR (
Name) (Address) (Tel. No.) DJ'
s Heating 8 AJC 6060 Labeaux Ave NE Albertville, MN 56301 (763) 497-2661 CONTRACTOR'
S1 LICENSE NUMBER (IF APPLICABLE) PLUMBING
BERG COMPLETED BY (PLEASE CHECK. ONE): HOMEOWNER
CONTRACTOR X IF
APPLICABLE, SPECIFY CONTRACTOR Lic # PMOSS420 CHECK
ALL TF AT APPLY: TOILET _ SINK BAR SINK BATHTUB/SHOWER LAUNDRY
TUB x SOFTENER Water Heater OTHER TOTAL #
OF FixTURES 2 14EMIN,
D,ER: IF ; W DO NOT OWN THIS PROPERTY OR ARE NOT PERFORMING THE WORK PERMIT MUST BE P ULLED BY .
AMSTER ,P,t UMBER) MECHANICAL
BEING COMPLETED BY (PLEASE CHECK Old•)&): HOMEOWNER
CONTRACTOR x IF
APPLICABLE SPECIFY CONTRACTOR CHECK .
ALL THAT APPLY- x FURNACE x A/C FIREPLACF BATHFAN TOTAL #
OF FI S 2 Bond #MB002987 WORK:
WORK: Iq '3Uonwo r,,-1 AIL. WA t%G 9030.
00 PD
EST)MATVALUE OF CONSTRUCTION Approved by Building Official: Date Approved:
Applicant Signatare `
Date 505 Walnut Street,
Suite #1 Monticello, MN 55362 Phone: 763-295-3060 Fax: 763-295-4404