2007-00327CITY OF MONTICELLO
505 WALNUT STREET
MONTICELLO, MN 55362-
763) 295-3000 F'AX: (763) 295-4404
MHUHNIFEEM
2007-00327*
DATE ISSUED: 05/03/2007
ADDRESS 6367 86TH ST NE
PIN 155160010060
LEGAL DESC CARLISLE VILLAGE
LOT 006 BLOCK 010
PERMIT TYPE PLUMBING
PROPERTY TYPE SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE LAWN SPRINKLER
NOTE: DO NOT PLACE IN PUBLIC RIGHT OF WAY
NUMBER OF PLUMBING FIXTURES 1
APPLICANT PLUMBING BASE FEE, RESI
PLUMBING FIXTURES
45.00
9.00
SUNRISE PLUMBING
11092 61ST STREET NE
STATE SURCHARGE, PLBG FIX 0.50
ALBERTVILLE, MN 55310- TOTAL 54.50
763) 497-2124 Payment(s)
CHECK 20961 54.50
OWNER
HAGEN,KENNETH C & KRISTA K
6367 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.
MONTICELLO
DEVELOPMENT SERVICES
BUILDING INSPECTIONS
505 WALNUT STREET, SUITE I
MONTICELLO, MN 55362
City Hall (763) 295-2711
PERMIT +-
PID #
Building Inspections (763) 295-3060 Fax (763) 295-4404
I
Please Print -INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED.
SITE ADDRESS: p f ZONED
LEGAL: Lot Block Plat
Property Owner Name: 9iSA, Phone:4 %7—
Address: City: State: Zip:
Contractor Name: Phone:
State License #: eao
Address: 1M9,;? City: i% State: & Zip:,7 30/
Eng./Architect Name: Phone:
Address: City: State: Zip:
Plumber Name: Phone:
Address: City: State: Zip:
Mechanical Name: Phone:
Address: City: State: Zip:
Type of Work Type of Construction Building Information
New 18, Single Family Use of building
Addition Duplex of stories
1, Alteration Multi -Family Floor area sq. ft.
Repair Commercial Estimated value
Move Industrial of construction $
Other Residential Garage Is this a "Master Plan" per MN Rule
Other 1300.0160 Subp.6.? Yes No
Description of work:
I hereby apply for a permit for construction as described and acknowledge that the information I have provided above is complete and accurate. I
agree that the work will be conducted in conformance with the ordinances of the City of Monticello and with the Laws of the State of Minnesota;
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 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.
641pplicaSignature
SEE BACK FOR PLUMBING
Q AND MECHANICAL INFO.
Application Date
APPLICANT.- Please show. fixtures that are applicable.
Fire Suppression : (if applicable) Plumbing: (if applicable) 1Ylechanical..- (if applicable)
No. Fixture Type No. Fixture Tvne No. Fixture Tvne
Sprinkler Heads Writer Closet (toilet) Furnace
Other/Special FSDevice Bathtub Gas Meter
Lavatory ()vash basin)
Shover
Kitchen Sink
Range Hood
Gas Range
Water Heater
Dish vsher
Laundry Tab
Air Conditioning
Alech. Fireplace
Fire Alarm: (if applicable) Clothes Washer Bathroom(s) Exhaust Fan
Water Heater Air Exchanger
No. Fixture Type Urinal Dryer
Drinking Fountain Gas Opening w/o Fixture
of Devices
Floor Drain
Outer Slop Sink
Hydrants
TOTAL TOTAL
9 Per Fixture) 9 Per F&ture)
1. E EME M, Imkim,_
P P-h;k j:
Bldg. Permit _
Plan Review
State Surcharge
Bldg. Total
Plmg. Permit
Fixtures
Surcharge
Plmg. TotalQ
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
TOTAL FEES: ef, 4j
Tree Ordinance Handout Yes No
Other Handouts Yes No
ADDITIONAL INFORMATION:
Valuation:
Construction Type:
Occupancy Group:
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: / /