2021-00157CITY OF MONTICELLO *
2 > 2 1— 0 0 1 5 7505WALNUTSTREETDATEISSUED: 03/11/2021
MONTICELLO, MN 55362-
763) 295-3060 FAX: (763) 295-4404
Permit #: 2021-00157
ADDRESS 4219 86TH ST NE
PIN 155252003020
LEGAL DESC FEATHERSTONE 4TH ADDN
LOT 002 BLOCK 003
PERMIT TYPE PLUMBING
PROPERTY TYPE SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE WATER SOFTENER
NUMBER OF PLUMBING FIXTURES 1
APPLICANT PLUMBING BASE FEE, RESI 50.00
PLUMBING FIXTURES 9.00
CULLIGAN WATER
1100 1ST ST NE
STATE SURCHARGE, PLBG FIX 1.00
BUFFALO, MN 55313- TOTAL 60.00
763) 682-2762 Payment(s)
CHECK 173703 60.00
OWNER
RAMSDELL, SAMANTHA
4219 86TH ST NE
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
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF Permit No. '-151
Monticello
BUILDING SAFETY Date
i
RESIDENTIAL BUILDING PERMIT
ADDITION / ALTERATION / REMODEL
SITE ADDRESS
LEGAL DESCRIPTION
LOT
PLAT
1 6-/ AWTi 7(— 6t- Ca 1 M &% M>01.
BLOCK PI.D. NUMBER
OWNER (Name) (Address) (Tel. No.)
CONTRACTOR (Name) (Address) + (Tel. No.)
R A ttt-> l C si /emu vl 1/v 5 13
CONTRACTOR'SC/Uu
CENSE NUMBER APPLICABLE
PLUMBING BEING COMPLETED BY (PLEASE CHECK ONE):
HOMEOWNER CONTRACTOIj Q
IF APPLICABLE, SPECIFY CONTRACTOR
CHECK ALL THAT APPLY: TOILET SINK BAR SINK
LAUNDRY TUB SOFTENER
TOTAL # OF FIXTURES
Lic #
BATHTUB/SHOWER
OTHER
REMINDER: IF YOU DO NOT OWN THIS PROPERTY OR ARE NOT PERFORMING THE WORK, PERMIT MUST BE PULLED
B Y A 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
DESCRIPTION OF WORK:
Bond #
ESTIMATED VALUE OF CONSTRUCTION
Approved by Building Official:
J V! Date Approved:
Applicant Signature .(U t t df /w W K I 1 ' Date^,
1 c 0/
505 Walnut Street, Suite #1 Monticello, MN 55362 Phone: 763-295-3060 Fax: 763-295-4404 1 U