Sewer And Water Permit Application - City Of St. Louis Park, Minnesota printable pdf download

City of St. Louis Park

Sewer and Water Permit Application

Job Site Address: __________________________________________ Unit # __________ Zip __________

Total Project Valuation: $___________________________

The Applicant Is:

Owner

Contractor

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

Property Owner *Required*

Name_____________________________________________________________________________________

Address__________________________________________________________________ Unit # __________

City ____________________________________________________________ State ______ Zip __________

Phone (

)

Contractor

Name_____________________________________________________________________________________

Address___________________________________________________________________________________

City ____________________________________________________________ State ______ Zip __________

Phone (

)

License #

Property Use

Type of Structure

Type of Work

(check only one)

Residential

Water Line

New Fire Line

Disconnect

Commercial

Fire Line

New Sanitary Sewer

Repair

Industrial

Sanitary Sewer

New Storm Sewer

Replacement

Institutional

Storm Sewer

New Water Line

Public

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 _____________ S&W App/Date ________

Issued __________