2021-00465CITY OF MONTICELLO
505 WALNUT STREET
MONTICELLO, MN 55362-
763) 295-3060 FAX: (763) 295-4404
ADDRESS 4167 87TH ST NE
PIN 155252001040
LEGAL DESC FEATHERSTONE 4TH ADDN
LOT 004 BLOCK 001
PERMIT TYPE PLUMBING
PROPERTY TYPE SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE WATER SOFTENER
NUMBER OF PLUMBING FIXTURES
APPLICANT
CULLIGAN WATER
1100 1ST ST NE
BUFFALO, MN 55313-
763) 682-2762
OWNER
SALZL, MARK AND PAM
8857 4167 87TH 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. 1 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
2021-00465*
DATE ISSUED: 06/14/2021
Permit #: 2021-00465
PLUMBING BASE FEE, REST 50.00
PLUMBING FIXTURES 9.00
STATE SURCHARGE, PLBG FIX 1.00
TOTAL 60.00
Payment(s)
CHECK 173718 60.00
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
ACITY
OF
Monticello
BUILDING SAFETY
SITE ADDRESS
LEGAL DESCRIPTION
LOT
PLAT
Permit No - 4(ps-
Date
RESIDENTIAL BUILDING PERMIT
ADDITION / ALTERATION / REMODEL
S1 IV& , Mona: (ALO M AJ
BLOCK PI.D. NUMBER
OWNER (Name) (Address)
T lv A/6r, eA
CONTRACTOR (Name) (Address)
641 '1) Ub L C -Vrj 1100 9-1
CONTRACTOR'S LICENSE NUMBER (IF APPLICABLE)
PLUMBING BEING COMPLETED BY (PLEASE CHECK ONE):
HOMEOWNER CONTRACTOR k_
IF APPLICABLE, SPECIFY CONTRACTOR
CHECK ALL THAT APPLY: TOILET SINK BAR SINK
LAUNDRY TUB X SOFTENER
TOTAL # OF FIXTURES
Lic #
Tel. No.)
Tel. No.)
3 6 -X k
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 WORK:
jj
W11T
ESTIMATED VALUE OF CONSTRUCTION
Approved by Building Official:
ssob Date Approved:
BATHFAN
Applicant Signature JrtALO ("'('[Tj:"/ Date
505 Walnut Street, Suite #1 Monticello, MN 55362 Phone: 763-295-3060 Fag: 763-295-4404