2022-00034CITY OF MONTICELLO
505 WALNUT STREET
MONTICELLO, MN 55362-
763) 295-3060 FAX (763) 295-4404
ADDRESS 4416 86TH ST NE
PIN 155264002080
LEGAL DESC EDMONSON RIDGE
LOT 008 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-
17
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_ired at my expense.
Applicant i
Date
Bldg Official Date
2022-00034*
DATE ISSUED: OV2V2022
Permit #: 2022-00034
PLUMBING BASE FEE, RESI 50.00
PLUMBING FIXTURES 153.00
STATE SURCHARGE, PLBG FIX 1.00
TOTAL 204.00
Payment(s)
CREDIT CARD 9685 204.00
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
ACITY OFMonticello
BUll DING SAFETY
PERMIT # Z02Z _ 00 () 3
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: W/G ST /V,:!f ZONED
LEGAL: Lot Block Plat
Property Owner Name: fis d,' Phone:
Address: %% /`/ i, L City: loixle-_ State: Zip:
Contractor Name: 1"v. /, '
7-,
n _ Phone:
State License #: 60 7 /,S ' / E-Mail:
Address: A'73 k q Sr` City: An;,e '' , Statery Zip: _t;- Eng./
Architect Name: Phone: Address:
City: State: Zip: Plumber
Name: Phone: 7G 3 1..3_1 s417 Address:
City: State: Zip: Mechanical
Name: Phone: Address:
City: State: Zip: Type
of Work Tvve of Construction Building Information I
t New Single Family Use of building Addition
Duplex of stories Alteration
a Multi -Family Floor area sq. ft. Repair
Commercial Estimated value Move
Industrial of construction $ Cl
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 AND
MECHANICAL INFO. A
icant Signature Application Date
APPLICANT: Please show fixtures that are applicable.
Fire Suppression : (if applicable) Plumbink: (if applicable) Mechanical. (if applicable)
No. Fixture Tvve No. Fixture Tvve No. Fixture Type
Sprinkler Heads Water Closet (toilet) Furnace
Other/Special FS Device Bathtub Gas Meter
2_ Lavatory (wash basin) Range Hood
Shower Gas Range
Kitchen Sink Water Heater
Dishwasher Air Conditioning
L Laundry Tub Mech. Fireplace
Clothes Washer Bathroom(s) Exhaust Fan
Fire Alarm: (if applicable) Water Heater Air Exchanger
Urinal Dryer
No. Fixture Tvve Drinking Fountain Gas Opening w/o Fixture
Floor Drain
of Devices Slop Sink
Other Outside Faucet
Future Owner Information:
Name:
Address:
TOTAL TOTAL
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: / /