2012-00460CITY OF MONTICELLO * 2 0 1 2- 0 0 4 6 0*
505 WALNUT STREET
DATE ISSUED: 08/10/2012
MONTICELLO, MN 55362-
763) 295-3060 FAX: (763) 295-4404
ADDRESS 4332 87TH ST NE
PIN 155180004070
LEGAL DESC FEATHERSTONE 2ND ADDN
LOT 007 BLOCK 004
PERMIT TYPE PLUMBING
PROPERTY TYPE : SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE : NEW CONSTRUCTION
NUMBER OF PLUMBING FIXTURES 14
APPLICANT PLUMBING BASE FEE, RESI 45.00
PLUMBING FIXTURES 126.00
RICKS PLUMBING INC STATE SURCHARGE, PLBG FIX 5.00
1707 221 ST AVE NW
CEDAR, MN 55011-
TOTAL 176.00
763) 753-1935 PAID WITH CHECK # 12205
6,13k'AW1
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.
DEVELOPMENT SERVICES
BUILDING INSPECTIONS
505 WALNUT STREET, SUITE 1
MONTICELLO, MN 55362
MONTICELLO City Hall (763) 295-2711
PERMIT
PID it
Building Inspections (763) 295 3060 Fax (763) 295-4404
PIease Print - INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED.
SITE ADDRESS: 40 Y330 7 S wt-7
LEGAL: Lot Block Plat
Property Owner Name: 11,DJ4k /%c- j
Address: City:
Contractor Name: (K.'_k`s fi'/.'.4.- — t
State License #: C,;1"-71, o w /P?4
Address: I7el a 2j'q`/7 61 5% City: -
Eng./Architect Name:
Address:
Plumber Name:
Address:
Mechanical Name:
Address:
Tvne ofWork
New
Addition
Alteration
Repair
Move
Other
Description of work: Vlej , ,
Phone:
ZONED
State: Zip:
Phone: 7&lr-
State:ti-,,, Zip:Ss'Gi'/
Phone:
City: State: Zip:
Phone:
City: State: Zip:
Phone:
City: State: Zip:
Tvne of Construction
Single Family
Duplex
MuIti-Family
Commercial
Industrial
Residential Garage
Other
Building, Information
Use of building
of stories
Floor area sq. t.
Estimated value
of construction $
Is this a "Master Plan" per MN Rule
1300.0160 Subp.6? Yes No
FOR ROOF & SIDING PERMITS,
PLEASE PROVIDE # OF SQUARES
OF SHINGLES &/OR SIDING.
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 «9th 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 %vill be repaired at my expense.
App /tcant Sig aft de
SEE BACK FOR PLUMBING
AND MECHANICAL INFO.
Application Date
1,
l n
V
APPLICANT: Please showfixtures that are applicable. Fire
Sunbressi.on : (if applicable) Plurttbinz. rif applicable) Mechanical: (if applicable) No.
Fixture Tvoe No. Fixture Terse No. Fixture Tvne Sprinkler
Heads Z Pater Closet (toilet) Furnace Other/
Special FSDevice Bathtub Gas.Ueter i
Lailatoly (wash basin) Range Hood 1
Shower Gas Range L
Kitchen Sink If-ater Heater Dishwasher
fair Conditioning 1
Laundry Tub Meek Fireplace Fire
Alarm: (if applicable) Clothes KVasher Bathrooln(s) Exhaust Fun Water
Heater Air Exchanger No.
Fixture Tvpe urinal
Dryer Drinking,
Fountain Gas Opening fv/o FL-vture Floor
Drain 9
of Devices Stop Sink Other
Hydrants ILI
TOT -IL TOTAL S9
Per Future) S9 Per F&ture) N : -•
s
e f A..-.. w - - c:3r, :..-7 =x+T E,ey }yg. L }..+ ..111
C1, my
MI-
IM Y/sy i
f 4 , S
i3ie # ;
77h;_e— ..aaM*t F
ros FtJ2• S<".' L' iG3`'il}!a'iNs$:`i'i•'49Ri ka'1 xR+X,'S}
P' M" ..
wY$ f°f? Tree
Ordinance Handout Yes No FEES:
Other Handouts Yes No Bldg.
Permit Plan
Review State
Surcharge Bldg.
Total Plmg.
Pemut Fixtures
ADDITIONAL INFORMATION: Surcharge
Valuation: Plmg.
Total Construction Type: Mech.
Permit Occupancy Group: Fixtures
Division: Surcharge
Square Footage: 1l4eeh.
Total Ir of Stories: Server
Access t of Residential Units: Water
Access Maximum Occupancy: Water
Meter Fire Sprinklers: C1 Yes L_1 No Meter
Sales Tax Off -Street Parking Covered: 1i1eter
Total Off -Street Parking Uncovered: Sew &
Water Permit Trunk
Water Trunk
Sanitary Sewer Building Official Tnuik
Storm Sewer BPT: Lift
Station TOTAL
FEES: