2018-00290CITY OF MONTICELLO
505 WALNUT STREET * 2 0 1 8- 0 0 2 9 0*
DATE ISSUED: 05/14/2018
MONTICELLO, MN 55362-
763) 295-3060 FAX- (763) 295-4404
Permit #: 2018-00290
ADDRESS 4300 87TH ST NE
PIN 155180004090
LEGAL DESC FEATHERSTONE 2ND ADDN
LOT 009 BLOCK 004
PERMIT TYPE MECHANICAL
PROPERTY TYPE SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE FIREPLACE
NUMBER OF MECHANICAL FIXTURES l
APPLICANT MECHANICAL BASE FEE, RESI 45.00
MECHANICAL FIXTURES 9.00
ZYCHOWSKI, DERRICK
STATE SURCHARGE, MECH FIX 1.00
4300
87 TH ST NE TOTAL 55.00
MONTICELLO, MN 55362- Payment(s)
563) 329-0977
CASH 55.00
OWNER
ZYCHOWSKI, DERRICK
4300
87 TH 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. 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 NO3 " 0 ®a9®
Date 5 I I i Lo
RESIDENTIAL BUILDING PERMIT
ADDITION / ALTERATION / REMODEL
SITE ADDRESS
i' , / Joto 25S ` _ LEGAL
DESCRIPTION LOT
BLOCK PLAT
DQ-
V'Plr 2,4 ch®ems OWNER (
Name) CONTRACTOR (
Name) CONTRACTOR'
S LICENSE NUMBER (IF APPLICABLE) PI.
D. NUMBER Address)
Address)
s&
3-3a5-0`71 Tel.
No.) Tel.
No.) PLUMBING
BEING COMPLETED BY (PLEASE CHECK ONE): HOMEOWNER
CONTRACTOR IF
APPLICABLE, SPECIFY CONTRACTOR Lic # CHECK
ALL THAT APPLY: TOILET SINK BAR SINK BATHTUB/SHOWER LAUNDRY
TUB SOFTENER OTHER TOTAL #
OF FIXTURES REMINDER:
IF YOU DO NOT OWN THIS PROPERTY OR ARE NOT PERFORMING THE WORK, PERMIT MUST BE PULLED B
Y A 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
Q S tit/,2 PLOL.C-t I l' S' LL ESTIMATED
VALUE OF CONSTRUCTION 1
Applicant
Signature 505
Walnut Street, Suite #1 Monticello, MN 55362 Approved
by Building Official: Date
Approved: Date6"
Phone:
763-295-3060 Fax: 763-295-4404