2022-00125CITY OF MONTICELLO
505 WALNUT STREET * 2 0 2 2- 0 0 1 2 5*
DATE ISSUED: 03/15/2022
MONTICELLO, MN 55362-
763) 295-3060 FAX (763) 295-4404
Permit #: 2022-00125
ADDRESS 4458 86TH ST NE
PIN 155264002120
LEGAL DESC EDMONSON RIDGE
LOT 012 BLOCK 002
PERMIT TYPE PLUMBING
PROPERTY TYPE SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE NEW CONSTRUCTION
NUMBER OF PLUMBING FIXTURES 14
APPLICANT PLUMBING BASE FEE, RESI 50.00
PLUMBING FIXTURES 126.00
CROSSTOWN PLUMBING INC
STATE SURCHARGE, PLBG FIX 1.00
8641 HARDING AVE
MONTICELLO, MN 55362- TOTAL 177.00
763) 295-8939 Payment(s)
CHECK XXXX 177.00
OWNER
LSW INVESTMENTS LLC
4065 CHELSEA RD W
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
Monticello
BUILDING SAFETY
PERMIT # a d
505 WALNUT STREET, SUITE 1 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: yy`5 9 S ZONED
LEGAL: Lot Block Plat
Property Owner Name: - Phone:
Address: City: State: Zip:
Contractor Name: `v -pc— Phone: Ok - `S'? ( 1,-7-A
State License #: \P'C- E-Mail: ' _ 5-U \ Lj Cp (3_
Address: g,- Ck- City: State: 19-6 Zip:'5
Eng./Architect Name: Phone:
Address: City: State: Zip:
Plumber Name: Phone:
Address: City: State: Zip:
Mechanical Name: Phone:
Address: City: State: Zip:
Tvpe of Work Tvue of Construction Buildins Information
Cr- New Single Family Use of building
Addition Duplex of stories
Alteration El Multi -Family Floor area sq. ft.
Repair Commercial Estimated value
Move Industrial of construction $
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.
Ap "ant Application Date
77
APPLICANT: Please show_ratures that are applicable.
Fire Sunoression : (if applicable) Plumbing: (if applicable) Mechanical. (if applicable)
No. Fixture Tvue No. Fixture Tvne No. Fixture Tvne
Sprinkler Heads Water Closet (toilet) Furnace
Other/Special FSDevice Bathtub Gas Meter
Lavatory (wash basin) Range Hood
Shower Gas Range
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 Tvne Drinking Fountain Gas Opening w/o Fixture
Floor Drain
of Devices Slop Sink
Other Outside Faucet
1 TOTAL TOTAL
FOR CTt'Y U$E ONLY:` -
Future Owner Information• Tree Ordinance Handout Yes No
Other Handouts Yes No
Name:
Address:
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: / /
Building Official
BPT: / /