2015-00756CITY OF MONTICELLO *
2 0 1 S- 0 0 7 S 6*
505 WALNUT STREET DATE ISSUED: 12/22/2015
MONTICELLO, MN 55362-
763) 295-3060 FAX (763) 295-4404
ADDRESS 6298 86TH ST NE
PIN 155186001060
LEGAL DESC CARLISLE VILLAGE 3RD ADDN
LOT 006 BLOCK 001
PERMIT TYPE PLUMBING
PROPERTY TYPE : SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE WATER HEATER
NUMBER OF PLUMBING FIXTURES 1
APPLICANT PLUMBING BASE FEE, RESI 45.00
MONTICELLO PLMG, HTG &AIR
PLUMBING FIXTURES 9.00
P.O. BOX 180
STATE SURCHARGE, PLBG FIX 1.00
MONTICELLO, MN 55362- TOTAL 55.00
763) 314-0083 Payment(s)
CREDIT CARD 5949 55.00
OWNER
MARSHIK, DARIN
6298 86TH STREET 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. !,,S' -7
Monticello
BUILDING SAFETY Date
RESIDENTIAL BUILDING PERMIT
ADDITION / ALTERATION / REMODEL
SITE ADDRESS
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LEGAL DESCRIPTION
LOT BLOCK PI.D. NUMBER
PLAT
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OWNER (Name) (Address) — (Tel. No.)
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CONTRACTOR (Name) (Address) (Tel. No.)
CONTRACTOR'S LICENSE NUMBER (IF APPLICABLE)
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 #
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 CONTRACTOR
IF APPLICABLE, SPECIFY CONTRACTOR
CHECK ALL THAT APPLY: FURNACE A/C FIREPLACE
TOTAL # OF FIXTURES Bond #
DESCRIPTION OF
F,,
WORK:
ESTIMATED VALUE OF CONSTRUCTION
Approved by Building Official:
Date Approved:
BATHFAN
Applicant Signatur Date (s
505 Walnut Street, Sul #1 onticello, MN 55362 6 Phone: 763-295-3060 Fax: 763-295-4404