2015-00707CITY OF MONTICELLO
2 0 1 S- 0 0 7 0 7*
505 WALNUT STREET DATE ISSUED: 11/17/2015
MONTICELLO, MN 55362-
763) 295-3060 FAX: (763) 295-4404
ADDRESS 4297 87TH ST NE
PIN : 155180002110
LEGAL DESC FEATHERSTONE 2ND ADDN
LOT 011 BLOCK 002
PERMIT TYPE MECHANICAL & PLUMBING
PROPERTY TYPE SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE NEW CONSTRUCTION
NUMBER OF MECHANICAL FIXTURES 10 NUMBER OF PLUMBING FIXTURES 20
APPLICANT MECHANICAL BASE FEE, RESI 45.00
MECHANICAL FIXTURES 90.00
B & D PLUMBING & HEATING
STATE SURCHARGE, MECH FIX 1.00
4145 MACKENZIE COURT NE
ST MICHAEL, MN 55376- PLUMBING BASE FEE, RESI 45.00
763) 497-2290 PLUMBING FIXTURES 180.00
STATE SURCHARGE, PLBG FIX 1.00
TOTAL 362.00
Payment(s)
OWNER CHECK 551603 362.00
GOLD NUGGET DEVELOPMENT INC
8857 ZEALAND AVE N
BROOKLYN PARK, MN 55445-
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.
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CITY OF
Monticello
PERMIT # a ® BUILDING SAFETY
i
505 WALNUT STREET, SUITE 1 MONTICELLO, MN 55362
City Hall (763) i 95-2711 Building Inspections (763) 295-3060 Fax (763) 295-4404
Please Print - INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED.
SITE ADDRESS: d `) '7 "Cl l S-t` N) ZONED
LEGAL: Lot l I Block a Plat hQr—.,e
Property Owner Name: f "I-r ,``,,,,.e j < ; , , 'I j eA e r.J- Phone f -I t,-Q (3 - o,qJ a i
Address: '19 v' I ct h/ Vr. City: ,?) , f fir State: MN) Zip: SG ( cl
Contractor Name: ` ( , I} (- Phont 7 (3 `{ { - a_1 9 C-) ,
State License #:
Address: q 11-f 5 (A e, Ve n z t e C 4- 4X City: d 01 r J,-Okc 1 State: r n N Zip: S 5 2 ]
Eng./Architect Name: Phone:
Address: City: State: Zip:
Plumber Name: Phone:
Address: City: State: Zip:
Mechanical Name: Phone:
Address: City: State: Zip:
Tvoe of Work Tvoe of Construction Buildine Information
Pq New 15-, Single Family Use of building
Addition Duplex of stories
Alteration Multi -Family Floor area sq. ft.
Repair Commercial Estimated value
Move Industrial of construction $ '1,5 3 . v d p-un,6 ,
Other Other c u c-)
Description of work: ,-
etu'."'. -rtrl i/lo.'.r\,e 4ieA,NN
I hereby apply for a permit for constriction as described and acknowledge that the information 1 have provided above is complete and accurate. I
agree that the work will be conduct& 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 applice tion 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 his 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.
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SEE BACK FOR PLUMBING
V I
a AND MECHANICAL INFO. % 1
Applicant Signature Application Date fO
a5 7 '6- 7` 5-{ NE
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APPLICANT: Please show fixtures that are a iplicable 4
Fire Sunnression : (if applicable) Plumbine: (if applicable) Mechanical: (if applicable)
a
0 No. Fixture Tvae No. Fixture Tvae No. Fixture Tvae
Sprinkler Heads 3 Water Closet (toilet) +
rG . ._
Furnace
Other /Special FSDevice Bathtub d' Gas Meter
Lavatory (wash basin)-2 nsd Ic! _ Range blood s
Shower + n s • Ll . ` "°"5 ` _ Gas Ban,
i Kitchen Sinks j Water Muter t;
0 1 Dishwasher I Air Conditioning i
m Laundry Tub Mech. Fireplace
Clothes Washe ,,A P Bathroo n(s) Exhaust Fan f
Fire Alarm: (if applicable) Water Beater ej e t-r, Air Exchanger
Urinal ( Dryer
No. Fixture Tvue Drinking Fountain Gas Opening w/o Fixture r
1 Floor Dram
of Devices Slop Sink
Other Outside Faucet a
11 i yin l.0 Wi
TOTAL TOTAL
gYp
n i `' = ,e'i{X? a-, Er4II-1NO'WE
l'•
Future Owner Information• Tree Ordinance Handout Yes No
Other Handouts Yes. No
Name: 1.
Address::
City: ADDITIONAL INFORMATION:
Valuation:,
State: Zip: Construction Type: i.
Occupancy Group:
Phone #: Division:
Square Footage:
of Stories:
of Residential Units:.
Maximum Occupancy:
Fire Sprinklers: D Yes No
Off -Street Parking Covered:'
Off -Street Parking Uncovered:
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Building Official
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