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� CITY OF ORONO aPPLICATION FOR PLU,�iBIPIG PERMIT ,.✓3ox 66 (1335 So Brown Rd) L Crystal Bay, MN 55323 *************************************************************************** General Instrnctions � 1. You may apply for plumbinq permits by mail or in person at the City offices. 2. Mailed in applications are subject to the postage and handling fees shown below. Pezmit cards will be sent by return mail the same dap the agplication is received. 3. Permi.ts are not valid until yoa receive a permit card. 4. Work must not begin unless the permit card is available on the job site. 5. Plumbing permits may be issued to licensed contractors only. 6. When any new construction or remodelinq is involved, a separate building permit must be obtained. _ ... 7. All work must be done in accordance with State Code requirements. 8. All work must be inspected before it is covered. Call 473-7357. 24 honr notice reqnired. *************************************************************************** JOB SITE ADDRESS: D D c� - - Occupancy Type: Residential Commercial OWNER'S NAME: /�� {� �/��G/�%� Phone No. : ��/- �'j�� Mailing Address. s•,��, _ City: CONTRACTOR'S NAME: L�Vi¢��rc�✓,P �5�� , Bus. No. : ��"- Z� a Z Mailing Address: �p�� <>,�c,�dic�� s'T, City: �iv � Zip:�f//� : _ Master Plumber's State License No. :�j��, ��7_ City Cert. No. : *************************************************************************** . PLIIMBING FIXTIIRE SCHEDULE (Show number of fixtures of each type on each floor) _ FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER ------------- --^---�----- -_ ----(-- - ------------- ---- ---------�--------- ----- r--- � -- - S:ater Closet �� I 1_-__-_ Sewer Ejector�- j ------------ -- ! ------- -- T --- --------- --- ---•----- --------- ----- � .� � � � Lavatory � l�( ; Laundry Tray � ------------ � -� --—--- ------ ------ ------------- ---- ---•----- ---------�----- , - - � --`- - - ' I ; Bathtub f � I Washer . -------------1----------- y-- --- ------ -------------�---- --------- ---------r----- Shower i I Water Aeater I �_ I ,_.. . • I � -------------�-----=--•------------- ------ ------------- ---- --•----- --------- ----- � CC // •,. -.._:, Ritchen Sink ; X � Water Softner�_ 1_ I ---------------�� --�---- I ------I ---- ------------ --- -------I--------------- -- --- - - - { i � Disposal � Wet Bar I � , i -------------1-----�------ ------- ------ ------------- ---- ---�--- ---------�----- Dishwasher � ' Sumo Pump I -------------1---- --- -- --------- ------ ------------- ---- ------- ---------- ----� Sillcocks � I Misc. (List) ------------- - Floor Drains ------------- �- ---�---- --------- ------ ------------- ---- -------- ---------- ----- *************************************************************************** 1. Fixture Fee The minimum permit fee is $30.00 $ 3�.�c� _ Compute number of fixtures x $5/fixture _.1. _ x $3/fixture reset � - 2. State Surcharge $ .50 ; , r 3. Postage & Handlinq (Only mail-in apFlications) $ 1.50 . . . . ,. 4. TOTAL PERMIT FEE (add lines 1-3 above) $ �C�. S�b �� *************************************************************************** I. The undersigned hereby applies to the City of Orono for issuance of a Plumbing Fermit, ;: 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 al l statements made on this ��£ application are complete, true and correct. � - �., . , . � / � ?��--��.�t e: �" t Signature of Applicant: - � ,��- ��— �