2015-00533CITY OF MONTICELLO *
2 0 1 5- 0 0 5 3 3
505 WALNUT STREET DATE ISSUED: 08/17/2015
MONTICELLO, MN 55362-
763) 295-3060 FAX: (763) 295-4404
ADDRESS : 6291 86TH ST NE
PIN : 155186001040
LEGAL DESC : CARLISLE VILLAGE 3RD ADDN
LOT 004 BLOCK 001
PERMIT TYPE : MECHANICAL
PROPERTY TYPE : SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE : FIREPLACE
NUMBER OF MECHANICAL FIXTURES 1
APPLICANT MECHANICAL BASE FEE, RESI 45.00
MECHANICAL FIXTURES 9.00
JERRY DAHL HEATING & A/C LLC
STATE SURCHARGE, MECH FIX 1.00
1933 164TH LANE NE
HAM LAKE, MN 55304-
TOTAL 55.00
612) 386-0108
Payment(s)
Minnesota State License #: MECH-MB003685
CREDIT CARD 2756 55.00
OWNER
MEINHARDT, RONALD
6291 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.
Monticello
BUILDING SAFETY Date
RESIDENTIAL BUILDING PERMIT
ADDITION / ALTERATION / REMODEL
SITE ADDRESS
C 7.
G
LEGAL DESCRIPTION
LOT BLOCK PI.D. NUMBER
PLAT L
OWNER (Name) ! +lt CC- (Address)
Fel D 14 Z
CONTRACTOR (N a[me) (Address)
CONTRACTOR LICENSE NUMBER (IF APPLICABLE)
VNA
PLUMBING BEING COMPLETED BY (PLEASE CHECK ONE):
HOMEOWNER CONTRACTOR _
IF APPLICABLE, SPECIFY CONTRACTOR
CHECK ALL THAT APPLY: TOILET SINK BAR SINK
LAUNDRY TUB SOFTENER
TOTAL # OF FIXTURES
Lic #
1 -nOS3-3
Tel. No.)
r2 36 dC
Tel. No.)
BATHTUB/SHOWER
OTHER
REMINDER: IF YOU DO NOT OWN THIS PROPERTY OR ARE NOT PERFORMING THE WORK, PERMIT MUST BE PULLED
BYA MASTER PLUMBER)
MECHANICAL BEING COMPLETED BY (PLEASE CHECK ONE):
HOMEOWNER
IF APPLICABLE, SPECIFY CONTRACTOR
CHECK ALL THAT APPLY: FURNACE
CONTRACTOR
A/C FIREPLACE BATHFAN
TOTAL # OF FIXTURES Bond #
DESCRIPTION OF / /
WORK: i `-s 6Yf / v
9 <
G' A--S
ESTIMATED VALUE OF CONSTRUCTION
Approved by Building Official:
Applicant Signature Q
V
505 Waln treet, S ite #1 Monticello, MN 55362
Date Approved:
Date ,ate% ! C1 /
Phone: 763-295-3060 Fax: 763-295-4404