2018-00403CITY OF MONTICELLO
505 WALNUT STREET * Z 0 1 8- 0 0 4 0 3*
D
MONTICELLO,1i41V 55362-
ATE ISSUED: 06/21/2018
763) 295-3060 FAX: (763) 295-4404
Permit #: 2018-00403
ADDRESS 4253 86TH ST NE
PIN 155246001090
LEGAL DESC FEATHERSTONE 3RD ADDITION
LOT 009 BLOCK 001
PERMIT TYPE PLUMBING
PROPERTY TYPE SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE NEW CONSTRUCTION
NUMBER OF PLUMBING FIXTURES 17
APPLICANT PLUMBING BASE FEE, RESI 45.00
PLUMBING FIXTURES 153.00
RICKS PLUMBING INC
STATE SURCHARGE, PLBG FIX 1.00
1707 221ST AVE NW
CEDAR, MN 55011-
TOTAL 199.00
763) 753-1935
Payment(s)
CHECK 18264 199.00
OWNER
NOVAK-FLECK
8857 ZEALAND AVE N
BROOKLYN PARK, MN 55445-
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.
1 CITY OF
Monticello
BUILDING SAFETY PERMIT # q V3
505 WALNUT STREET, SUITE I MONTICELLO, MN 55362
City Hall (763) 295-2711 Building Inspections (763) 295-3060 Fax (763) 295-4404
BUILDING PERMIT APPLICATION
Please Paint - INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED.
SITE ADDRESS: Z6g S-t- NE ZONED LEGAL:
Lot Block PlatPXC- ,2,'c:), Property
Ovwner Name: kvw Cl.e-- V- 2C-- Phone: Address: City:
State: Zip: Contractor Name:
C 5 o Wrrblr \ n-C • Phone k0?2-- i.;1, State License #:
i t.-2. G':2— Address: \--ti
j f Uk e l City: C-eCkc -i— State: M N Zip: SS 011 Eng./Architect
Name: Address: Plumber
Name:
Address: Mechanical
Name:
Address: Tyne
of
Work XNew Addition
Alteration
Repair
0
Move
Other Description
of
work: City: City:
City:
Tvne
of
Construction X Single
Family Duplex Multi -
Family
Commercial Industrial
Other
unki-;,
ror
j Phone:
State:
Zip:
Phone: State:
Zip:
Phone: State:
Zip:
Buildina Information
Use of
building 4 of
stories Floor area
sq. ft. Estimated value
of construction $
T hem.
by apply for a pcmzait 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 petatit and that the work is not to start without a perruit. 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 AND MECHANICAL
INFO. Applicant Signature
0 Application Date d e6£:
80'26 66 AV
APPLICANT: Please show fbaures that are applicable.
Fire Suppression : (if applicable) Plumbing (if applicable) Mechanical: (if applicable)
No. Fixture Tvae No. Fixture Tvoe No. Fixture Tyne
Sprinkler Heads D Water Closet (toilet) Furnace
Other/Special FS Device Bathtub Gas Meter
Lavatory (wash basin) RangeSood
Shower Gas Range
Kitchen Sink Water Heater
Dishwasher Air CondidoWng
1 Laundry Tub Meek. Fireplace
k Clothes Washer Bathroonm(s) Exhaust Fan
Fire Alarm: (if applicable) Water Heater Air Exchanger
Urinal Dryer
No. Fixture Tvne Drinking Fountain Gas Opening Klo Fixture
Floor drain
of Devices Slop Sink
Outside Faucet0tbe,
J TOTAL TOTAL
FOR CITY USE ONLY.
Future Owner Information:
Name:
Address:
City:
State:
Phone #:
1 3
Zip:
Tree Ordinance Handout Yes No
Other Handouts Yes D No
ADDITIONAL INFORMATION:
Valuation:
Construction Type:
Occupancy Droop:
Division:
Square Footage:
of Stories:
of Residential Units:
Maximum Occupancy:
Fire Sprinklers: Yes
Off -Street Parking Covered:
Off -Street Parking Covered
Building Official
BPT:
No
Ful
Z,d
e6£:80'96 66 ady