2019-00861CITY OF MONTICELLO
505 WALNUT STREET
MONTICELLO, MN 55362- ,
763) 295-3060 FAX: (763) 295-4404
ADDRESS 4183 87TH ST NE
PIN 155252001020
LEGAL DESC FEATHERSTONE 4TH ADDN
LOT 002 BLOCK 001
PERMIT TYPE PLUMBING
PROPERTY TYPE SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE NEW CONSTRUCTION
NUMBER OF PLUMBING FIXTURES
APPLICANT
RICKS PLUMBING INC
1707 221ST AVE NW
CEDAR, MN 55011-
763) 753-1935
OWNER
NOVAK-FLECK
8857 ZEALAND AVE N
BROOKLYN PARK, MN 55443-
17
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
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2019-00861*
DATE ISSUED: 01/06/2020
Permit #: 2019-00861
PLUMBING BASE FEE, RESI 50.00
PLUMBING FIXTURES 153.00
STATE SURCHARGE, PLBG FIX 1.00
TOTAL 204.00
Payment(s)
CHECK XXXX 204.00
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE,
t `CITY OF
Mont icdo
SI:ILUING SAFETY
PERMIT #
505 WALNUT STREET, SUITE 1 MONTICELLO, MN 55362
City Hall (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: W.-7 9 1 .0 Mir A.
LEGAL: Lot Block Plat
Property Owner Name: 4&'k
Address: i City.
Contractor Name: ;t(,-S; I c
State License #: ` l
Address: Ila 7.Z,%` -- A4W City: /`'"j,"
Eng./Architect Name:
Address:
Plumber Name: Aue— (A4 t2
Address: i ;k i 2'Ll yam .•_- i
Mechanical Name:
Address:
Tvne of Work
PP —New
Addition
Alteration
Repair
Move
Other
Description of work: /
r•
Phone:
Phone:
ZONED
State: Zip:
State: Zip:.iS241
Phone:
City: State: Zip:
Phone: Y'%
City: G um State. AI+f` Zip: 53r7f/
Phone:
City: State: Zip:
Tvue of Construction
li- Single Family
Duplex
Multi -Family
Commercial
Industrial
Other
Building Information
Use of building
r` of stories
Floor area sq. ft.
Estimated value
of construction $ ,/_tom
r
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 confbrnrn aance 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 fiuther 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.
SEE BACK FOR PLUMBING
Z - AND MECHANICAL INFO.
Applicant Signature Application Date
L,d
e9Z:0 6 `6 6 £Z 0e0
APPLICANT.- Please showlWares that are applicable:
Fire Sunaression : (if applicable) Plumbing: ('applicable) Mechanical. (if applicable)
No. Fixture Tvne No. Fixture Tvae No. Fixture Tvue
Sprinkler Heads Water Closet (toilet) Furnace
Other/Special FSDevice Bathtub Gas Meter
Lavatory (wash basin) Range Hood
Shower Gas Range
Kitchen Sink Water Heater
Dishwasher Air Conditioning
i Laundry Tub Mech. Fireplace
Clothes Washer Batkroom(s) Exhaust Fan
Fire Alarm: (if applicable) Water Heater Air Exchanger
Urinal Dryer
No. Fixture Tvne Drinking Fountain Gas Opening w/o Fiviure
1' Floor Drain
of Devices Slop Sink
Other 2, Outside Faucet
11— TOTAL TOTAL
Future Owner Information:
FOR CITY USE ONLY.
Tree Ordinance Handout Yes No
Other Handouts Yes No
Name:
Address:
City: ADDITIONAL INFORMATION:
State: Zip:
Valuation:
Construction Type:
Phone #:
Occupancy Group:
Division:
Square Footage:
of Stories:
of Residential Units:
Maximum Occupancy.
Fire Sprinklers: Yes
Off -Street Parldng Covered:
Off -Street Parking Covered
Building Official
BPT:
10
0
Z•d
e9Z:M '66 £Z 080