2020-00856CITY OF MONTICELLO
505 WALNUT STREET * 2 0 2 0— 0 0 8 S 6*
DATE ISSUED: 10/28/2020
MONTICELLO, MN 55362-
763) 295-3060 FAX: (763) 295-4404
Permit #: 2020-00856
ADDRESS 8628 GATEWAY CIR
PIN 155250012020
LEGAL DESC CARLISLE VILLAGE 6TH ADDN
LOT 002 BLOCK 012
PERMIT TYPE PLUMBING
PROPERTY TYPE SINGLE FAMILY -ATTACHED
CONSTRUCTION TYPE NEW CONSTRUCTION
NUMBER OF PLUMBING FIXTURES 11
APPLICANT PLUMBING BASE FEE, RESI 50.00
PLUMBING FIXTURES 99.00
MN PLUMBING PRO
STATE SURCHARGE, PLBG FIX 1.00
10793 256TH AVE NW
ZIMMERMAN, MN 55398- TOTAL 150.00
763) 227-6172
Payment(s)
CREDIT CARD 9131 150.00
OWNER
CARLISLIE VILLAGE LLC
2850 CUTTERS GROVE AVE
STE 207
ANOKA, MN 55303-
AGREEMENT AND SWORN STATEMENT
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
Monticello
BUILDING SAFETY PERMIT#
505 WALNUT STREET, SUITE 1 MONTICELLO, MN 55362
City Hall (763) 295-2711 Building Inspections (763) 295-3060 Fax (763) 295-4404
BUILDING PERMIT APPLICATION
Please Print - INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED.
SITE ADDRESS: 'Z5 %-te- C) i rcAe— ZONED
LEGAL: Lot Block Plat
Property Owner Name: Ce,.ar ; ,' % ( C_ Phone:
Address: 2 -- Pam, ` d.,vLje_ -city: („k-- Kee- State: 4%A Zip: r
Contractor Name: An )PJ'u o ja,:70 Phone: %3- Z-2 7- 6/7?
State License #: It `708 E-Mail: ,oa (09 &,o ,P`aMj_,j '•Z ;R.V
I--
c
Address: /6? ;S 14c.Ae- iuJ City: OzwO! el State: Zip:
Eng./Architect Name: Phone:
Address: City: State: Zip:
Plumber Name:I&I,) PI/V LlC_ Phone: -2 --10i7Z
Address: ll) 'k Z6y-- City: State: Zip:
Mechanical Name: Phone:
Address: City: State: Zip:
Twe of Work Tvne of Construction Buildine Information
J& New A Single Family Use of building
Addition Duplex of stories
Alteration 0 Multi -Family Floor area sq. ft.
Repair Commercial Estimated value
Move Industrial of construction
Other Other
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. 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
6-2 7 Oe 2 ® AND MECHANICAL INFO.
Applicant Signature Application Date
APPLICANT: Please show fixtures that are aoplicabla
Fire Suppression: (if applicable) Plu`nbine: (if applicable) Mechanical: (if applicable)
No. Fixture Tvoe No. Fixture Tvae No. Fixture Tvae
Sprinkler Heads Water Closet (toilet) Furnace
Other/Special FS Device T Bathtub Gas Meter
7__ Lavatory (wash basin) Range Hood
Shower Gas Range
Kitchen Sink Water Heater
ZDishwasher Air Conditioning
Laundry Tub Mech. Fireplace
Clothes Washer Bathroom(s) Exhaust Fan
Fire Alarm: (if applicable) Water Heater Air Exchanger
Urinal Dryer
No. Fixture Tvae Drinking Fountain Gas Opening w/o Fixture
T F' oor Drain
ofDevices Slop Sink
Other 9ptside Faucet 4.
TOTAL TOTAL
Future Owner Information:
Name:
Address:
FOR CITY USE ONLY
Tree Ordinance Handout Yes No
Other Handouts Yes No
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: / /