Fillable MECHANICAL PERMIT APPLICATION 12800 Ravine Pkwy S, Cottage (City of Cottage Grove)

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MECHANICAL PERMIT APPLICATION 12800 Ravine Pkwy S, Cottage (City of Cottage Grove)

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MECHANICAL
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:
PROJECT ADDRESS:
OWNER/OCCUPANT INFORMATION:
Name:
Phone:
Address:
State:
Zip:
Email:
CONTRACTOR INFORMATION:
Name:
Phone:
Address:
State:
Zip:
Email:
State License/Bond #:
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 VALUE
PROJECT DESCRIPTION
$
RESIDENTIAL
FEES
Base Fee: $50 (includes 1 fixture) – Add $10 for each additional fixture
New Single Family Dwelling $200
Furnace
$10
#
Fireplace
$10
#
Air Conditioner
$10
#
Garage/Unit Heater
$10
#
Air Exchanger
$10
#
Gas Appliance
$10
#
Boiler
$10
#
Gas Piping
$10
#
Duct Work Only/Extension
$10
#
Heat Pump
$10
#
Exhaust Fan
$10
#
In Floor Heat
$10
#
Other/Misc.:____________________________________________________________________
$10
#
License Verification Fee $5.00
State Surcharge $1.00
COMMERCIAL FEES
Project Value (materials & labor)
$
Permit Fee (project value x .02 or $75, whichever is greater)
$
State Surcharge (project value x .0005)
$
TOTAL:
$
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MECHANICAL PERMIT APPLICATION 12800 Ravine Pkwy S, Cottage (City of Cottage Grove)

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Completed 21 January 2021

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