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2021-00526CITY OF MONTICELLO 505 WALNUT STREET MONTICELLO, MN 55362- 763) 295-3060 FAX: (763) 295-4404 ADDRESS 4201 86TH ST NE PIN 155252003010 LEGAL DESC FEATHERSTONE 4TH ADDN LOT 001 BLOCK 003 PERMIT TYPE BUILDING PROPERTY TYPE SINGLE FAMILY -DETACHED CONSTRUCTION TYPE SWIMMING POOL VALUATION 4,000.00 NUMBER OF 1/4 HOURS 1 APPLICANT PALINSKY, ELLEN & KEVIN 4201 86TH STREET NW MONTICELLO, MN 55362- OWNER PALINSKY, ELLEN & KEVIN 4201 86TH STREET NW 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 2 0 2 1— 0 0 S 2 6* DATE ISSUED: 07/01/2021 Permit #: 2021-00526 BUILDING PERMIT FEE 103.09 STATE SURCHARGE, BLDG VAL 2.00 RECORD RESEARCH & COPIES 15.00 TOTAL 120.09 Payment(s) CREDIT CARD 120.09 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF I -ECROVE , Permit NoZIMonticello DateBUILDINGSAFETYJUN292V1 46 In .% SITE ADDRESS Z e'-)1 LEGAL DESCRIPTION LOT PLAT J RESIDENTIAL BUILDING PkR1V*IT ADDITION i )u.Y j& REMODEL BLOCK 19"R UIlul 3:1:I OWNER EI (Name) (Address) keVPal /01s ky )-1201 f6A Sk iJE CONTRACTOR (Name) ( Address) t- CONTRACTOR' S LICENSE NUMBER (IF APPLICABLE) PLUMBING BEING COMPLETED BY (PLEASE CHECK ONE): HOMEOWNER V CONTRACTOR IF APPLICABLE, SPECIFY CONTRACTOR CHECK ALL THAT APPLY: TOILET SINK BAR SINK LAUNDRY TUB SOFTENER TOTAL # OF FIXTURES Lic # Tel. No.) 6 3 - 2 yy - () ?08 Tel. No.) BATHTUB/SHOWER OTHER REMINDER: IF YOU DO NOT OWN THIS PROPERTY OR ARE NOT PERFORMING THE WORK, PERMIT MUST BE PULLED BYA MASTER PLUMBER) MECHANICAL BEING COMPLETED BY (PLEASE CHECK ONE): HOMEOWNER CONTRACTOR IF APPLICABLE, SPECIFY CONTRACTOR CHECK ALL THAT APPLY: FURNACE A/C FIREPLACE BATHFAN TOTAL # OF FIXTURES Bond # DESCRIPTION OF WORK: Pv k / L7 vj> & ,,, / c p o ©d i h -kv Fop 9/e C ®r 6 k yid , 28 ' rev^j 1 qg" sJ&P,.'a f ESTIMATED VALUE OF CONSTRUCTION tv1/C90 0 + r Applicant Signature 505 Walnut eet, Suite #1 Monticello, MN 55362 Approved by Building Official: . A/r Date Approved: 71112-0 Date b - 2 1 — Z / Phone: 763-295- 3060 Fax: 763-295-4404 z 4 p O W m z= g p o a mom NW N T5 Z FW46 U- o M M s Q CL o 6 O pam Wwla1 zip, y R O 6%-a Y d • 03 a ma qw O O to'.-°z omyVo- o No 4 m L eve 04 4tA Wz .a IWO OD` = - Uqg351'1 1 W 9 a t or L4" l ` B f - '"' _ —' r •es .yam+ m 1 a 6 , O ow vzCO IF , y Al or 4 6,pm• yf 74'SY1 3.tf,9Po9 N 6' q `U ' 1 N N 11 J O N In 1 z 0 w p O 7,:5 N T 7 CD t iJ G N ; Q O O1- L