2007-00595CITY OF MONTICELLO
505 WALNUT STREET
MONTICELLO, MN 55362-
763) 295-306U YAX: (763) 295-44U4
2007-00595*
DATE ISSUED: 07/16/2007
ADDRESS 6318 86TH ST NE
PIN 155186001080
LEGAL DESC CARLISLE VILLAGE 3RD ADDN
LOT 008 BLOCK 001
PERMIT TYPE PLUMBING
PROPERTY TYPE SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE LAWN SPRINKLER
NOTE: SPRINKLER SYSTEM
NUMBER OF PLUMBING FIXTURES 1
APPLICANT PLUMBING BASE FEE, RESI
PLUMBING FIXTURES
45.00
9.00
SHADOW CREEK CORPORATIONOW
STATE SURCHARGE, PLBG FIX 0.50
172 RD
MN 55340-
TOTAL 54.50
Payment(s)
CASH 54.50
OWNER
CLARK, JAMES
6318 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.
MONTICELLO
DEVELOPMENT SERVICES PERMIT #
BUILDING INSPECTIONS PID #
505 WALNUT STREET, SUITE I
MONTICELLO, MN 55362
City Hall (763) 295-2711 Building Inspections (763) 295-3060 Fax (763) 295-4404
Please Print - INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED.
SITE ADDRESS:
LEGAL: Lot
Property Owner Name:
Address: R A
Block Plat
City:
Contractor Name: Phone:
State License #:
Address:
EngJArchitect Name:
Address:
Plumber Name:
Address:
Mechanical Name:
Address:
Tvne of Work
New
Addition
Alteration
Repair
Move
Other *.In4LL"`
work:
4i
City:
City:
City:
City:
Tvne of Construction
f Single Family
Duplex
Multi -Family
Commercial
Industrial
Residential Garage
Other
ik
0_11IC)
State: FIN Zip:
Phone:
Phone:
Phone:
State Zip:
State: Zip:
State: Zip:
State: Zip:
Building Information
Use of building 1 U
of stories
Floor area sq. ft.( n
Estimated value
of construction $
Is this a "Master Plan' per MN Rule
1300.0160 Subp.6.? 13 Yes E3 No
I hereby apply for a permit for construction as described and acknowledge that the information I have provided above is complete and accurate. IagreethattheworkwillbeconductedinconformancewiththeordinancesoftheCityofMonticelloandwiththeLawsoftheStateofMinnesota; 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 willbeinaccordancewiththeplanthathasbeenapprovedbytheBuildingOfficial. I agree that any damage caused to public property including but
not limited to curb, sidewalk, p blic utilities and signs will be repaired at my expense.
I SEE BACK FOR PLUMBING
INFANDMECHANICAL O•
App t Signature Appli 'on ate
APPLICANT: Please show fixtures that area Wicable.
Fire Suppression : (if applicable) Plumbing: (if applicable) Mechanical: (if applicable)
No. Fixture Type
Sprinkler Heads
Other / Special FS Device
Fire Alarm: (if applicable)
No. Fixture Tyne
of Devices
Other
Bldg. Permit
Plan Review
State Surcharge
Permit
Surcharge
No. Fixture Tvoe
Water Closet (toilet)
Bathtub
Lavatory (wash basin)
Shower
Kitchen Sink
Dishwasher
Laundry Tub
Clothes Washer
Water Heater
Urinal
Drinking Fountain
Floor Drain
Slop Sink
Hydrants
Bldg. Total
Plmg. Total
Mech. Permit
Fixtures
Surcharge
Mech. Total
Sewer Access
Water Access
Water Meter
Meter Sales Tax
Meter Total
Sew & Water Permit
Trunk Water
Trunk Sanitary Sewer
Trunk Storm Sewer
Lift Station
AL FEES:
TOTAL
9 Per Fixture)
No. Fixture Type
Furnace
Gas Meter
Range Hood
Gas Range
Water Heater
Air Conditioning
Mech. Fireplace
Bathroom(s) Exhaust Fan
Air Exchanger
Dryer
Gas Opening w/o Fixture
TOTAL
9 Per Fixture)
Tree Ordinance Handout Yes No
Other Handouts Yes No
Valuation:
Construction Type:
Occupancy Oroup:
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: —