2021-00249CITY OF MONTICELLO
505 WALNUT STREET * 2 0 2 1— 0 0 2 4 9*
DATE ISSUED: 04/07/2021
MONTICELLO, MN 55362-
763) 295-3060 FAX: (763) 295-4404
Permit #: 2021-00249
ADDRESS 4173 87TH ST NE
PIN 155252001030
LEGAL DESC FEATHERSTONE 4TH ADDN
LOT 003 BLOCK 001
PERMIT TYPE PLUMBING
PROPERTY TYPE SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE NEW CONSTRUCTION
NUMBER OF PLUMBING FIXTURES 18
APPLICANT PLUMBING BASE FEE, RESI 50.00
PLUMBING FIXTURES 162.00
RICKS PLUMBING INC
STATE SURCHARGE, PLBG FIX 1.00
1707 221STAVE NW
CEDAR, MN 55011- TOTAL 213.00
763) 753-1935 Payment(s)
CHECK 18330 213.00
OWNER
NOVAK-FLECK
8857 ZEALAND AVE N
BROOKLYN PARK, MN 55443-
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
Monticello
BUILDING SAFETY
PERMIT # 71 — wzl-q
505 WALNUT STREET, SUITE I MONTICELLO, MN 55362
CityHall (763) 295-2711 Building Inspections (763) 295-3060 Fax (763) 295-4404 BUILDING
PERMIT APPLICATION Please
Print - INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED. SITE
ADDRESS: 4173 87th St Ne LEGAL:
Lot 3 Block 1 Property
Owner Name: Novak Fleck Address:
Contractor
Name: Ricks Plumbing Inc State
License #: PC642862 Address:
1701 221 St Ave NW Eng./
Architect Name: Address:
Plumber
Name: Same as above Address:
Mechanical
Name: Address:
Tvne
of Work El
New Addition
Alteration
Repair
Move
Other
Description
of work: New
home single family plumbing ZONED
Plat
Feather stone 4th Phone:
City:
State: Zip: Phone:
763-753-1935 E-
Mail: Rickplumbinginc@gmail.com City:
Cedar State: MN Zip: 55011 City:
City:
City:
TVDe
of Construction ED
Single Family Duplex
El
Multi -Family Commercial
Industrial
Other
Single Family Phone:
State:
Phone:
State:
Phone:
State:
Buildine
Information Use
of building of
stories Floor
area sq. ft. Estimated
value of
construction $ Zip:
Zip:
Zip:
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. 4-
6-21 Applicant
Signature Application Date SEE
BACK FOR PLUMBING AND
MECHANICAL INFO.
APPLICANT. Please show fixtures that are applicable.
Fire Suppression : (if applicable) Plu`rtbine: (if applicable) Mechanical. (if applicable)
No. Fixture Tvoe No. Fixture Tvae No. Fixture Tvue
Sprinkler Heads 3 Water Closet (toilet) Furnace
Other/Special FS Device 2 Bathtub Gas Meter
3 Lavatory (wash basin) Range Hood
3 Shower Gas Range
1 Kitchen Sink Water Heater
1 Dishwasher Air Conditioning
Laundry Tub Mech. Fireplace
1 Clothes Washer Bathroom(s) Exhaust Fan
Fire Alarm: (if applicable) 1 Water Heater Air Exchanger
Urinal Dryer
No. Fixture Tvoe Drinking Fountain Gas Opening w/o Fixture
1 Floor Drain
of Devices Slop Sink
Other 2 Outside Faucet
18 TOTAL TOTAL
Future Owner Information:
Name: Matt and Elena Schrader
Address:
FOR CITY USE ONLY
Tree Ordinance Handout Yes No
Other Handouts Yes No
City: ADDITIONAL INFORMATION:
Valuation:
State: Zip: Construction Type:
Occupancy Group:
Phone #: 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: / /