2012-00345CITY OF MONTICELLO 2 0 1 2— 0 0 3 4 5*
DATE ISSUED: 06/20/2012
505 WALNUT STREET
MONTICELLO, MN 55362-
763) 295-3060 FAX: (763) 295-4404
ADDRESS 406 7TH ST E
PIN 155029002070
LEGAL DESC LAURING HILLSIDE TERRACE
LOT 007 BLOCK 002
PERMIT TYPE BUILDING
PROPERTY TYPE COMMERCIAL
CONSTRUCTION TYPE ALTERATION
VALUATION 7,742.00
APPLICANT BUILDING PERMIT FEE 162.45
STATE SURCHARGE, BLDG VAL 5.00
LARSON BUILDING
TOTAL 167.45
3 STATE HWY 55
BUFFALO, MN 55313-
PAID WITH CHECK # 1205
763) 688-5430
OWNER
ALLIED PROPERTY MANAGEMENT
20125 COMMERCIAL BLVD. #1000
ROGERS, MN 55374-
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
PERMIT r: 17_ —MNS
PID #
505 WALNUT STREET, SUITE 1
MONTICELLO, MN 55362
City Hall (763) 295-2711 Building Inspections (763) 295-3060 Fax (763) 295-4404
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Please Print - INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED.
SITE ADDRESS: 'Llob %', i" 71 S/..t ZONED
LEGAL: Lot Block Plat
Property Owner Name: e -J),,a J& ,citi: 04,, LLC Phone: 74 ,7- VdS-- ADGD
Address: / 3RS" c a Nj,'// ss,_ity: err State: Zip:
S'trife ,?Qd C i ic 1/c N Nee '
Contractor Name:_ qar sorl 13t. _` d ,,A vt_t- _ _ Phone: 76 -T- $ 2-/ f3%e
State License #: N 4
Address: i S.ic ,,,i Q City:1 , State:. lA.-Le Zip: S,Cli
Eng./Architect Name: Pam:
Address: . City: State: Zip:
Plumber Name: Phone:
Address: _ State: Zip:
Mechanical Name: / ne•
Address: _ / City: Sta `e" Zip:
Tvne of Work
New
Addition
Alteration
Repair
Move
1W Other De mod
Tvi)e of Construction
Single Family
Duplex
Multi -Family
N' Commercial
Industrial
Residential Garage
C.7 Other
Description of work: _,C r jrw O -7 -74; 9 .5' ,
Buildine Information
Use of building
of stories
Floor area sq. -ft. -17
Estimated value
of construction $
Is this a "Master Plan" per MN Rude
1300.0160 Sttbp.6? Yes No
FOR ROOF & SWING PERIMITS,
PLEASE PROVIDE # OF SQUARES
OF SHINGLES &IOR SIDING.
F`,q f 1
1 hereby apply for a permit for construction as described and acknowledge that the information 1 have provided above is complete and accurate. I
agree that the work will be conducted in conibrnance with the ordinances of the City of Monticello and with the Laws of the State of Minnesota;
and that 1 understand that this application is not a permit and that the work is not to start without a permit I fitrther understand that the work
will be in accordance with the plats 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
1 l ? / Z AND MECHANICAL INFO,
Applicant ignature Appllcatio]Aate
ISJ 1
APPLICANT Please show fixtures that are applicable
Fire S'umression : (if applicable) Plumbinn: (if applicable) Mechanical. (if applicable)
No. Fixture Tvoe NO. Fixture Tvne No. Fixture Tvne
Sprinkler Heads 1Srater Closet (toilet) Furnace
Other/Special FS Device Batlatib Gas Meter
Lavatory (wash basin) Range Hood
Sltorver Gas Range
Kitchen Sink Water Heater
Dishivasher Air Conditioning
Laundry Tab hfech. Fireplace
Fire Alarm: (if applicable) Clothes Washer Buthroonr(s) Exhaust Fan
Mater Fleater Alr Exchanger
No. Fixture Tvne
Urinal Dryer
DrinkingTountatn Gas Opening sv/o lirtnre
Door Drain
h of Devices Slop Sink
Other Hydrants
TOTAL 1OT JL
S9 Per FLvture) ( S9 Per Future)
Tree Ordinance Handout Yes No
FEES: Other Handouts Yes No
Bldg. Pennit
Plan Review
State Surcharge
Bldg, Total
Pling. Permit
Fixtures ADDITIONAL INFORMATION:
Surcharge Valuation: i Y 7-
Pinig. Total Construction Type: f
Mech. Permit Occupancy Group:
Fixtures Division:
Surcharge Square Footage:
iblech, 'Total of Stories:
Sewer Access of Residential Units:
Water Access Maximum Occupancy:
Water Meter Fire Sprinklers: U Yes H No
Meter Sales Tax Off -Street Parking Covered:
Meter Total Off -Street Parking Uncovered:
Sew & Water Permit
Trunk Water
Trunk Sanitary Sewer Building Official/ J2-
Trunk Storm Sewer BPT: 1 1
Lift Station
TOTAL FEES: