2021-00571CITY OF MONTICELLO
505 WALNUT STREET
MONTICELLO, MN 55362-
763) 295-3060 FAX: (763) 295-4404
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 WATER SOFTENER
NUMBER OF PLUMBING FIXTURES
APPLICANT
CULLIGAN WATER
1100 1ST ST NE
BUFFALO, MN 55313-
763)682-2762
OWNER
SCHRADER, MATT & ELENA
4173 87TH STREET 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
MUNIUMMIMEM
2 0 2 1— 0 0 5 7 1*
DATE ISSUED: 07/15/2021
Permit #: 2021-00571
PLUMBING BASE FEE, REST 50.00
PLUMBING FIXTURES 9.00
STATE SURCHARGE, PLBG FIX 1.00
TOTAL 60.00
Payment(s)
CHECK 173721 60.00
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF Permit No.,
Aw,_>GMonticello
BUILDING SAFETY Date
RESIDENTIAL BUILDING PERMIT
ADDITION / ALTERATION / REMODEL
SITE ADDRESS
Lll -i 9- Tr S'- MG, /Vica-mccut M/l/ 5-53a.
LEGAL DESCRIPTION
LOT BLOCK PI.D. NUMBER
PLAT
OWNER (Name) (Address)
1 A-Tt ULpj" SC k(2-AP I - ET
CTOR (
Name) (Address) v
tO Cd[-Z I/M s% 5T IV6— CONTRACTOR'
S LICENSE NUMBER (IF APPLICABLE) PLUMBING
BEING COMPLETED BY (PLEASE CHECK ONE): S
aF nc Mil HOMEOWNER
CONTRACTOR IF
APPLICABLE, SPECIFY CONTRACTOR CHECK
ALL THAT APPLY: TOILET SINK BAR SINK LAUNDRY
TUB - SOFTENER TOTAL #
OF FIXTURES Lic #
Tel.
No.) Tel.
No.) J3
9d,-- 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 BATHFAN TOTAL #
OF FIXTURES Bond # DESCRIPTION
OF WORK:: r
ESTIMATED
VALUE OF CONSTRUCTION Applicant
Signature d,) Atc) CLt l,G l} Approved
by Building Official: Date
Approved: Date
a Phone:
763-295-3060 Fax: 763-295-4404 505WalnutStreet, Suite #1 Monticello, MN 55362