2022-00017CITY OF MONTICELLO
505 WALNUT STREET
MONTICELLO, MN 55362-
763) 295-3060 FAX: (763) 295-4404
ADDRESS 4408 86TH ST NE
PIN 155264002070
LEGAL DESC EDMONSON RIDGE
LOT 007 BLOCK 002
PERMIT TYPE PLUMBING
PROPERTY TYPE SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE NEW CONSTRUCTION
NUMBER OF PLUMBING FIXTURES
APPLICANT
S & S PLUMBING INC
18738 93RD STREET
BECKER, MN 55308-
763) 263-5599
OWNER
LSW INVESTMENTS LLC
4065 CHELSEA RD W
MONTICELLO, MN 55362-
19
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
2022-00017*
DATE ISSUED: 01/1 V2022
Permit #: 2022-00017
PLUMBING BASE FEE, RESI 50.00
PLUMBING FIXTURES 171.00
STATE SURCHARGE, PLBG FIX 1.00
TOTAL 222.00
Payment(s)
CHECK 10176 222.00
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF
Monticello
BUILDING SAFETY PERMIT
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 Print - INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED.
SITE ADDRESS: 29r 5 7- ZONED
LEGAL: Lot Block Plat
Property Owner Name: , /-® Phone: ' " e1`! > 7 3
Address: / -3 City: State: ,31 A,.) Zip: J_ -k
7
Contractor Name: sd -5 sh S: —e' = Phone: 'S Z9,e
State License #: 1 y5 7 / E-Mail: 55 /.
Address: y 3 - ,,n S T City: '& C e State. r Zip: - '
Eng./Architect Name:
Address:
Plumber Name:
Address:
Mechanical Name:
Address:
Tvne of Work
XNew
Addition
Alteration
Repair
Move
Other
Description of work:
City:
City:
City:
Tvve of Construction
Single Family
Duplex
Multi -Family
Commercial
Industrial
Other
Phone:
State:
Phone:
State:
Phone:
State:
Buildine Information
Use of building
of stories
Floor area sq. ft.
Estimated value
of construction $
Zip:
Zip:
Zip:
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
AND MECHANICAL INFO.
Applicant Signature Application Date
APPLICANT. Please show fixtures that are applicable.
Fire Sunnression : (if applicable) PlumbiniL (if applicable) Mechanical: (if applicable)
No. Fixture Tvue No. Fixture Tvoe No. Fixture Tvue
Sprinkler Heads Water Closet (toilet) Furnace
Other / Special FS Device Bathtub Gas Meter
Lavatory (wash basin) Range Hood
Shower Gas Range
I Kitchen Sink Water Heater
Dishwasher Air Conditioning
Laundry Tub Mech. Fireplace
Clothes Washer Bathroom(s) Exhaust Fan
Fire Alarm: (if applicable) Water Heater Air Exchanger
Urinal Dryer
No. Fixture Tvoe Drinking Fountain Gas Opening w/o Fixture
Floor Drain
of Devices Slop Sink
Other Outside Faucet
Future Owner Information:
Name:
Address:
TOTAL TOTAL
FOR MY 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: / /