Permits - Permit# 00-10P - 4325 Channel Road - 1/1/20006124719160 CITY OF SPRING PARK
841 P01 JUN 23 100 09:26
CITY OF SPRING PARK
P.O. BOX 452
SPRING PARK, MIlNNESOTA 55384
612-471-9051
APPLICATION FOR PLUMBING PERMIT
G .1\ l RA1, INFO MAMON
1, You may apply for plumbing permits by mail or in person at the City otiice9. PERMITS ARE NOT
VALID UNTIL YOU RECEIVE A PERMIT. WORK MJST NOT BEGIN UNTIH, TM P�_RMr_r
t' LO IS POSTED ON THE JOB SITE.
3. Plumbing permits may be lowed ONLY to licensed plumbing contractors and to property owners
residing in the dwelling.
4. When any new construction or remodeling is involved, a separate building permit must be obtained.
5. All work must be done in accordance with the State Code requirements.
6. All work mast be inspected and air tested before it is covered Call 2494600. A 24-hour notice
required.
INSTRUCTIOIITB Complete all items on this application. Compote the permit fee. Sign and date the
certification. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. V you have questions, . call
249-4600.
Please check one: New Addition_ Repair Replace
Residential Commercial
JOB SITE: N 3`>5
Owner's Name _
Malllna Address
Contractor's Name -1
Malling Address
Number _ CASa - Pi i - 133
. C-. Phone Number N -1 1) - c to 5 5
"ME BSMT 1ST 2ND OTHER FIXTURE BSMT 1ST 2ND OTHER
Poor Quality Document
Disclaimer
The original or copy of a document or page of a document
presented at the time of digital scanning contained within this
digital file may be of substandard quality for viewing, printing or
faxing needs.
6124719160 CITY OF SPRING PARK
Phmbkg Pezzuk Application
841 P02 JUN 23 100 09:27
1. 1.25% Of Contract Price* or Minimum Fee (S35.001
x.0125
Contract Price
2. State SucharM ** Add the State Building Code Division
Surcharge to each permit Saey a .0005
Contract Price
or S.50, whichever is greater
S 35.00
$ ' Sa
3. Postage Wd 1lia_ndling (Only mail -in applications) S Si s0
4. TOTAL PERMIT FEE (Add lines 1-3 above) S
* CONTRACT PRICE OR JOB COST means the actual or estimated dollar amount charged for the
permitted work including materials, labor, profit, and other fixed costs. It is the amount to be charged
to the customer for the work done. If any material, equipment, labor, or installation are furnished by
the owner, tenant or any other party the reasonable market value of such items must be added to the
estimated cost or contract price for the permit fee purposes. In the event that there is a dispute on the
amount of the job cost, the City may request the submission of a signed copy of the actual contract.
** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or S.50, whichever
is greater. For valuations over S1,000,000 call the Department of Inspectional Services for the price.
The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all work in strict
accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that
all statements made on this application are complete, true and correct.
Applicant's Signature Dj z()e Date to(ail00
2