Plumbing Permit Application - City Of St. Louis Park, Minnesota

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City of St. Louis Park

Plumbing Permit Application

Job Site Address: ___________________________________________ Unit # __________ Zip __________

Project Valuation: $___________________________

The Applicant Is:

Owner and Occupant

Contractor

(must include fair market value of material and labor costs)

Property Owner *Required*

Name___________________________________________Email_______________________________________

Address__________________________________________________________________ Unit # ____________

City ______________________________________________________________ State ______ Zip __________

Phone (

)

Contractor

Name___________________________________________Email_______________________________________

Address_____________________________________________________________________________________

City ______________________________________________________________ State ______ Zip __________

Phone (

)

MN State License #

Property Use

Type of Structure

Type of Work

Residential

Principal Building

New Building

Commercial

Garage

Existing Building

Disconnect

Industrial

Accessory Building

Addition

Code Compliance

Institutional

Temporary Building

Remodel

R.P.Z Overhaul or

Public

Swimming Pool

Repair / Replace

Replacement

Other__________

Plumbing Item(s) (indicate quantity for each)

___ Add Basement Bath

___ Flammable Waste

___ Sewage Ejector

___ Urinal

___ Add First Floor Bath

___ Floor Drain

___ Shower

___ Water Closet

___ Add Second Floor Bath

___ Garbage Disposal

___ Sillcock / Hose Bib

___ Water Cooler

___ Bathtub w/ Shower

___ Grease Interceptor

___ Sink - Bar

___ Water Filter

___ Bathtub w/out Shower

___ Ice Maker

___ Sink - Food Prep

___ Water Heater

___ Coffeemaker

___ Indirect Waste

___ Sink - Handwash / Lavatory

___ Water Meter

___ Dishwasher

___ Laundry Tub

___ Sink - Janitor

___ Water Pipe

___ Drinking Fountain

___. Pressure V. Breaker

___ Sink - Kitchen

___ Water Softener

___ Fixture Rough-In Only

___ R.P.Z

___ Sink - Three Compartment

___ Whirlpool

___ Fixture Set on Existing R.I.

___ Roof Drain

___ Standpipe

___ Other

Specific Description of Work to be Completed

Permit becomes void if work does not begin within 180 days or if suspended at any time over the 180 days. Permits issued and inspection made by the City are a public

service and do not constitute any representation, guarantee or warrant, either implied or expressed, to any person as to the condition of the building or conformance to

applicable construction codes. The Undersigned acknowledges that this application has been read and that the above is correct and agrees to comply with all the ordinances

and laws of the City of St. Louis Park regulating building construction.

Some or all of the information that you are asked to provide on the application is classified by State law as either private or confidential. Private data is

information which generally cannot be given to the public but can be given to the subject of the data. Confidential data is information which generally cannot be given to

either the public or the subject of the data. Our purpose and intended use of this information is annually to update our records and records of other governmental agencies

required by law. If you refuse to supply the information, the permit may not be issued.

Applicant’s Name & Signature

Date

Print & Sign Name

Permit # ______________________

Called ______________________ Ck_________ CC

OFFICE USE

ONLY

Entered ____________ Zoning App/Date _____________ Approval/Date ________

Issued __________