Fillable BUILDING PERMIT APPLICATION ISLAND (City of Cottage Grove)

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BUILDING PERMIT APPLICATION ISLAND (City of Cottage Grove)

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GREY CLOUD
ISLAND
BUILDING
PERMIT APPLICATION
12800 Ravine Pkwy S, Cottage Grove, MN, 55016 Phone: 651-458-2804
Email: building@cottagegrovemn.gov Website:www.cottagegrovemn.gov
OFFICE USE ONLY
Permit Number:
NEW HOME ONLY
PIN:
Legal Description (Lot, Block, Subdivision):
PROJECT ADDRESS:
OWNER/OCCUPANT INFORMATION:
Name:
Phone:
Address:
Zip:
Email:
CONTRACTOR INFORMATION:
Name:
Phone:
Address:
Zip:
Email:
State License #:
Contact Name:
APPLICANTS SIGNATURE:
Applicant certifies that all information is correct and that all pertinent state regulations and city ordinances will
be complied with in performing the work for which this permit is issued.
Printed Name:
Date:
Signature:
Date:
PROJECT VALUATION
PROJECT DESCRIPTION
No construction is allowed until the permit has been paid for & issued.
Questions? Call 651-458-2804
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BUILDING PERMIT APPLICATION ISLAND (City of Cottage Grove)

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Completed 21 January 2021

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