2012-00592iiiiiiiiiiiiiiiiiiiiiillillillillillillilliim
CITY OF MONTICELLO * 2 0 1 2- 0 O 5 9 2*
505 WALNUT STREET
DATE ISSUED: 10/23/2012
MONTICELLO, MN 55362-
763) 295-3060 FAX: (763) 295-4404
ADDRESS 406 7TH ST E STE 400
PIN 155029002070
LEGAL DESC LAURING HILLSIDE TERRACE
LOT 007 BLOCK 002
PERMIT TYPE PLUMBING
PROPERTY TYPE COMMERCIAL
CONSTRUCTION TYPE ALTERATION
VALUATION $ 7,000.00
APPLICANT PLUMBING BASE FEE, COMM 100.00
STATE SURCHARGE, PLBG VAL 5.00
COX PLUMBING
TOTAL 105.00
17041 172ND AVENUE SE
BIG LAKE, MN 55309- PAID WITH CHECK # 4873
763)263-2731
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.
ilIONTICELLO
DEVELOPMENT SERVICES
PERMIT -
BUILDNG INSPECTIONS PID
505 WALN'UT'STREET, SUITE 1
MONTICELLO, NhN 55362
City Ball (763) 295-2711 Building Inspections (763) 295-3060 Fax (763) 295-4404
Pease Print - INCOMPLETE APPLICATIONS NYILL NOT BE ACCEPTED.
SITE ADDRESS: yD(p ?"-4 5E"Ad [,t % ZONED LEGAL:
Lot Block Plat Property
Owner Name: )/yjo Fe c llc, l,r4, one: 7i'o— yob'' 7ao0 Address:
A;lla Ci State Zip: Contractor
Name: 0-6X pl"rAI` Ph°...e: State
License #: _ , y7 v yy Q Address: /
74ell /% /fry S_ City: 2,16,&e State: `tZoll, Zip;$j o Eng./Architect
Name: Address: Z0S-
17 _ , l City: Co Id Plumber Name:
Address: City:
Mechanical Name:
Address: City:
Tvne of
Work New Addition
Alteration
Repair
Move
Other
Description
of
Fvprk: %1-d) G1.vLD/
Tvne of
Construction Single Family
Duplex Multi -
Family
Commercial D
Industrial
Residential Garage
Other i
Phone:
9,
2v low= 33oS Sv, State:
AAA, Zi.p: s v P
ne:
Phone: State:
Zip:
State: Zip:
Building Information
Use of
building tf of
stories Floor area
sq. ft. Estimated value
of construction
Is this
a "Master Plan" pec t IN Rule 1300.0160
Subp.6? Yes No FOR ROOF &
SIDING PERl4'IITS, PLEASE PROVIDE #
OF SQUARES OF SHINGLES &/
OR SIDING. I hereby
apply for a permit for construction as described and .acluiowledge 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 thelaws 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 Nxill 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. A licant
Signature SEE BACK
FOR PLUMBING AND MECHANICAL
INTFO. Application Date
4&,0C)
APPLICANT. Please show ftatires that are applicable.
Fire Sirnnression : (if applicable) Plumbing: (if applicable) _ 1 echanical: (if applicable)
No. Fixture Tvoe No. Fixture Time No. Fixture TvDe
Sprinkler Heads L TVater Closet (toilet) Furnace
Other/Special FSDeuice Bathtub Gas.,11eter•
2 Lavatory (wash basin) Range Hood
Shower Gas Range
Kitchen Sink 111aterHeater
Dishwasher Air Conditioning
LartndryTub Meek Fireplace
Fite Alarm: (if applicable) Clothes T3'asher Bathrooms) Exhaust Farr
TT-ater Heater Air Exchanger
No. Fixture TNsoe
Urinal Dryer
Drinking Fountain Gas Opening rr/o Future
Floor Drain
b of Devices Slop Sink
Other Hydrants
TOTAL TOT,4L
S9 Per Fixture) (S9 Per Fkvture)
y.nA :Y:
i '
9.'•`. 't.V- + 4: -+
5 '
ac 'S^G.:;y -. 3;r, Ky.`C:...
y ) .i nt. r:+C-•i . .' +iY:ji: 'ati'-_P ivF'iaN b w''.Y9^ er,S •f' 'ji??C.' •(-•,-."1- 4c 9_ +(
3',-'ti".yri3 {s4.F" C'•_.:c."1,.^.. f :3i. ° :"':
Y
t-e-T'Lrt•:a5'+,,,.;i: s*v n.- .:YVY` .•cr?c;Y .s,.=a . Y.. r.!!''tt-::'+
t. _—ei src'ittst;. 'v_,- a'+h+-.`...r a Ie:.±. ..
may '
qi.,• ,". ,y..
t..'.'t:,: .r. .' ..s,-a.. _ •"AR:'.a2s-$sec.'.-.rY:.;i;re+:'s?:kri.=,6ii_'wtacc+L;r"e.;SL:.zirc''.+h.`eet:+evt,.+s.....e'3?xi t4'•-t'K,'<''z*
Tree Ordinance Handout l 'Yes No
FEES: Other Handouts Yes No
Bldg. Permit
Plan Review
State Surcharge
Bldg. Total
Plmg. Permit
Fixtures ADDITIO`'AL INFORMATION:
Surcharge Valuation: (
Plmg. Total Construction Type:
Mech. Permit Occupancy Group:
Fixtures Division:
Surcharge Square Footage:
1llech. Total r of Stories:
Sewer Access r of. Residential Units:
Water Access Maximum Occupancy: ,
Water Meter Fire Sprinklers: L Yes L -To
Meter Sales Tax Off -Street Parkins Covered:
Meter Total Off-StreetParking Uncovered:
Sew & Water Pennit
Trunk Water
Trunk Sanitary Sewer Building Official
Trunk Stonn Sewer BPT: / 1
Lift.Station
TOTAL FEES:
moo0