2017-00865CITY OF MONTICELLO lllllllllllllllllllllllllllllllllllllllllllllllllllllllllll
505 WALNUT STREET * 2 0 1 7- 0 0 B 6 5*
DATE ISSUED: I V20/2017
MONTICELLO, MN 55362-
763) 295-3060 FAX: (763) 295-4404
Permit #: 2017-00865
ADDRESS 6305 86TH ST NE
PIN 155186001020
LEGAL DESC CARLISLE VILLAGE 3RD ADDN
LOT 002 BLOCK 001
PERMIT TYPE PLUMBING
PROPERTY TYPE SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE WATER SOFTENER
NUMBER OF PLUMBING FIXTURES l
APPLICANT PLUMBING BASE FEE, RESI 45.00
PLUMBING FIXTURES 9.00
LARSON PLUMBING
STATE SURCHARGE, PLBG FIX 1.00
3095 162ND LANE NW
ANDOVER, MN 55304- TOTAL 55.00
763) 427-7680 Payment(s) ts)
CHECK 003320 55.00
OWNER
PRIBLE, SHANE & JULIE
6305 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.
PermitNo.
M04i effo
BUILDING SAFETY
Date
RESIDENTIAL BUILDING PERMIT
ADDITION / ALTERATION / REMODEL
SITE ADDRESS
6305 86th St NE
LEGAL DESCRIPTION
LOT BLOCK PI.D. NUMBER
PLAT
OWNER (Name) (Address) (Tel. No.)
Shane Pribyl 6305 86th St NE 763-370*-7147
CONTRACTOR (Name) (Address) (Tel. No.)
Larson Plumbing Inc 3095 162nd LN NW Andover, MN 55304 763-427-7680
CONTRACTOR'S LICENSE NUMBER (IF APPLICABLE)
PC 643733
PLUMBING BEING COMPLETED BY (PLEASE CHECK ONE):
HOMEOWNER CONTRACTOR XX
IF APPLICABLE, SPECIFY CONTRACTOR Lic # PC 643733
CHECK ALL THAT APPLY: TOILET SINK BAR SINK BATHTUB/SHOWER
LAUNDRY TUB 1 SOFTENER OTHER
TOTAL # OF FIXTURES 1
REMINDER: IF YOU DO NOT OWN THIS PROPERTY OR ARE NOT PERFORMING THE WORK, PERMIT MUST BE PULLED
BY A MASTER PLUMBER.)
MECHANICAL BEING COMPLETED BY (PLEASE CHECK ONE):
HOMEOWNER CONTRACTOR
IF APPLICABLE, SPECIFY CONTRACTOR
CHECK ALL THAT APPLY: FURNACE A/C FIREPLACE BATHFAN
TOTAL # OF FIXTURES Bond #
DESCRIPTION OF WORK:
Install Water Softener
ESTIMATED VALUE OF CONSTRUCTION
1100.00
Applicant Signatureppg _
505 Walnut Street, Suite #I Monticello, MN 55362
Approved by Building Official:
Date Approved:
Date 11/15/17
Phone: 763-295-3060 Fax: 763-295-4404