2014-00598CITY OF MONTICELLO 11111111111111 E 11111111111111111111IIIII IIIII IIIII IN III
2 0 1 4- 0 0 S 9 8
505 WALNUT STREET DATE ISSUED: 10/07/2014
MONTICELLO, MN 55362-
763) 295-3060 FAX: (763) 295-4404
ADDRESS 6295 86TH ST NE
PIN 155186001030
LEGAL DESC CARLISLE VILLAGE 3RD ADDN
LOT 003 BLOCK 001
PERMIT TYPE MECHANICAL
PROPERTY TYPE SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE FIREPLACE
NUMBER OF MECHANICAL FIXTURES 1
APPLICANT MECHANICAL BASE FEE, REST 45.00
MECHANICAL FIXTURES 9.00
DJ'S HEATING & A/C
STATE SURCHARGE, MECH FIX 5.00
6060 LABEAUX AVENUE NE
ALBERTVILLE, MN 55301- TOTAL 59.00
763) 428-2661 Payment(s)
CHECK 6191 59.00
OWNER
CHAD & TRACY, HINZ
6295 86TH ST
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.
OCT-6-2014 04:09 FROM: TO:2954404 P.1
CITY OF permit No. + { I 1` L
Monticello (III
DateH1111-0ING SAF[TY
RESIDENTIALBUILDING PERM.TT ADDITION /
ALTERATION / REMODEL SITE
AnottEss, LEGAL
DESCRIPTION LOT
PLAT
BLOCK
PLD, NUMfiCR OWNI'
sR (Name) r (
Address) (
Tel. No.) f
1 n Ga, V 1C7,1 ce- ' `.4.eJ 7 CONTRACTOR (
Name) (Address) (Tel, No.) CONTRACTOR'
S LICENSE NI IMRI;R (IF APPLICABLE) r
PLUMBING
HEING COMPLETED BY (PLEASE CHECK ONE): HOMEOWNER
OMEOWNERCONTRACTOR TF
APPLICABLE, SPECIFY CONTRACTOR CHECK
ALI,'I HAT APPLY: TOILET SINK DAR SINK 13AITITIJB/SHOWE11 LAUNDRY
TUB SO I'I:NIr;R OTHER TOTAL #
OF FTXTLIIZFS RLMINDER:
IF YOU DO NOT OWN THIS PROPERTP OR ARE NOT PERFORMING 7'1•/r WORK, PR/?Ailr misr BE PULLED 8 )'
A MASTER PL UM8.13R..) MECHANICAL
BEING COMPLETED BY (PLEASE CHECK ONE;): I•
IOML'•OWNER CONTRACTOR IF
APPLICABLE, SPECIFY CONTRACTOR CHECK
ALL TTIAT APPLY: FURNACE A/C n
FIREPLACE
BATHFAN TOTAL
N OF FIXTURES Build Jl oc DESCRIPTION
OI' ` WORK:
I n ESTIMAI
ED VALUE OF CONSTRUCTION Approved
by Building Official: Dulc
Aphrovcd: Applicam
Signatur, Date f v (1 50.
1 Walnut Street, Suite #1 Monticello, MN 55362 Phone: 763-295-3060 Fax: 763-295.44114