Fillable PLUMBING PERMIT APPLICATION (City of Cottage Grove)

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PLUMBING PERMIT APPLICATION (City of Cottage Grove)

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DENMARK
TOWNSHIP
PLUMBING
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:
Email:
CONTRACTOR INFORMATION:
Name:
Phone:
Address:
State:
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 VALUE
PROJECT DESCRIPTION
$
RESIDENTIAL FEES
Base Fee: $50 (includes 1 fixture) – Add $10 for each additional fixture
New Single-Family Dwelling
$200
Sink/Laundry Tub
$10
#
Bathtub/Shower
$10
#
Sump Pump
$10
#
Clothes Dryer
$10
#
Swimming Pool
$10
#
Clothes Washer
$10
#
Water Closet
$10
#
Dishwasher
$10
#
Water Heater
$10
#
Garbage Disposal
$10
#
Water Softener
$10
#
Hose Bib
$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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PLUMBING PERMIT APPLICATION (City of Cottage Grove)

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Completed 21 January 2021

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