2020-00689CITY OF MONTICELLO mHoulufffflum
505 WALNUT STREET * Z 0 2 0- 0 0 6 8 9
DATE ISSUED: 08/27/2020
MONTICELLO, MN 55362-
763) 295-3060 FAX: (763) 295-4404
Permit #: 2020-00689
ADDRESS 8628 GATEWAY CIR
PIN 155250012020
LEGAL DESC CARLISLE VILLAGE 6TH ADDN
LOT 002 BLOCK 012
PERMIT TYPE MECHANICAL
PROPERTY TYPE SINGLE FAMILY -ATTACHED
CONSTRUCTION TYPE NEW CONSTRUCTION
NUMBER OF MECHANICAL FIXTURES 7
APPLICANT MECHANICAL BASE FEE, RESI 50.00
MECHANICAL FIXTURES 63.00
R HVAC
1125 MISISSISSIPPI DRIVED
STATE SURCHARGE, MECH FIX 1.00
CHAMPLIN, MN 55316- TOTAL 114.00
612) 802-6525 Payment(s)
Minnesota State License #: MB004223 CREDIT CARD 1043 114.00
OWNER
HEADWATER HOMES
11140 ZEALAND AVE N
CHAMPLIN, MN 55316-
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.
CITY OF
Mont lla
BUILDING SAFETY
Pam. Zb l0$4 505
WALNUT STREET; SUITE 1 MONTICELLO, MN 55362 City
Hall (763) 295-2711 Building Inspections (763) 295-3060 Fax (763) 295-4404 wT,
Please
Print - INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED. SITE
ADDRESS: WA G +ek Code., ZONED LEGAL:
Lot Block Plat Property
Owner Name: 4&Auja,+q- Nois AJ Phone: Address:
City: State: Zip: Contractor
Name: Ptt)Aer `4V Al: Phone: _(Qa - SOZ • & 6'ZC' State
License #: E-Mail:_uJa.S fv k-et •Iwo, C-001 Address:
II2.T MirsisSindi drew. City: Cl». State: N Zip: SS316 EngJArchitect
Name: Address:
Plumber
Name: Address:
Mechanical
Name: Address:
Tvne
of Work New
Addition
Alteration
Repair
Move
Other
Description
of work: City:
City:
City:
Tvne
of Construction Single
Family Duplex
Multi -
Family Commercial
Industrial
Other
Phone:
State:
Zip: Phone:
State:
Zip: Phone:
State:
Zip: Buildine
Information Use
of building of
stories Floor
area sq. ft. Estimated
value of
construction $ 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 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. SEE
BACK FOR PLUMBING tom
8 - 2`T - Z o AND MECHANICAL INFO. Applicant
Signa Application Date t
1
APPLICANT. Please show -fixtures that are applicable
Fire Sunnression : (if applicable) Plumbine: (if applicable) Mechanical. (iapplicable) No.
Fixture Tvue No. Fixture TVDe No. Fixture Tvue Sprinkler
Heads Water Closet (toilet) Furnace Other /
SpecialFS Device Bathtub Gas Meter Lavatory (
wash basin) Mange Hood Shower
Gas Range Kitchen
Sink Water Heater Dishwasher
Air Conditioning Laundry
Tub Mech. Fireplace Clothes
Washer _ Bathroom(s) Exhaust Fan Fire
Alarm: rf applicable) Water Heater _ Air Exchanger Urinal
Dryer No.
Fixture Tvue Drinking Fountain Gas Opening w/o Fixture y
FloorDrainof
DevicesSlop Sink Other
Outside Faucet TOTAL
TOTAL FOR
CITY USE ONLi( 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
Official BPT:
11