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�� <br /> • CiTY OF ORONO APPLICATION FOR PLUMBING PERMIT <br /> � " Box 66 (1335 So Brown Rd) <br /> Crystal Bay, MN 55323 $���� � �� S� <br /> *************************************************************************** <br /> General Instructions <br /> 1. You may apply for plumbing permits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fees shown below. <br /> Permit cards will be sent by return mail the same day the application is received. <br /> 3. permits are not valid until you receive a permit card. <br /> 4. Work muat not begin unless the permit card is available on the job site. <br /> 5. Plumbing permits may be issued to licensed contractors only. <br /> 6. When any new construction or remodeling is involved, a separate building permit must <br /> be obtained. <br /> 7. All work muat be done in accordance with State Code requirements. <br /> 8. All work must be inspected before it is covered. Call 473-7357. <br /> 24 honr notice reqnired. <br /> ********,k****it*irir**,k*,t*****itic*it�`*it**itir**ir*it******it***,�j,k*it****,k************* <br /> JOB SITE ADDRESS: � � J �'�-7 i t.J c>c���� f�..� <br /> Occupancy Type: _�_Residential ommercial <br /> OWNER'S NAME: �f7 c/< � �:���,�%rZ� S Phone No. : <br /> Mailing Address: City: <br /> n <br /> CONTRACTOR'S NAME: �'��JiVI S ���'� fi-��,1v/�..✓t._ Bus. No. : �f�7SL - `j'2 c� 7 <br /> Mailing Address: 5�zr �.-� .-.,,3�., J)ie City: �-n�r� S��C Zip: >> 3� I <br /> Master Plumber's State License No. : ?� 2..�- �j City Cert. No. : <br /> *************************************************************************** <br /> PLUMBING FIXTURE SCHEDULE <br /> (Show number of fixtures of each type on each floor) <br /> FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER <br /> _�_�.________� ��_� ___-1���'� ___T�__�� ��_�__ ____�_�_�___ _�__ �_�._r�___ ___�����_ _��__ <br /> Water Closet ( Sewer Ejector <br /> ------------- ---- ---—---- ---- ---- ------ ------------- ---- ---•----- --------- ----- <br /> Lavatory 7 Laundry Tray <br /> Bathtub � Washer <br /> ------------- -----�------- ------- ------ ------------- ---- -------- --------- ----- <br /> Shower � Water Heater <br /> Ritchen Sink l --__-_ Water Softner <br /> -------------+---- --�----- -------- ---------- ---- --�----- -------- ---- <br /> Disposal I_ Wet Bar <br /> -------------1 --- ---- ----- ---- ----------- -- --•---- -------- ---- <br /> Dishwasher Sump Pump <br /> Sillcocks Misc. (List) <br /> Floor Drains <br /> ������������� ����� ���i���� ���a����� ������ ������������� ���� ���r���� ���������� <br /> 'A'�C7t7k�C*7Y*�'****A*7k**'k**�l7F*'k A**7k'A 7t A*�C'A*'k**�(*****7E**7k�f�F*'k'�C*********�'**A*'k**'kA"�G* ' <br /> l. Fixture Fee The minimum permit fee is $30.00 $ <br /> Compute number of fixtures x $5/fixture <br /> x $3/fixture reset <br /> 2. State Surcharge $ .50 <br /> � <br /> � 3. Postage & Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ <br /> *************************************************************************** <br /> The undersigned hereby applies to the City of Orono for issuan<:e of a Plumbing Permit, <br /> agrees to do all work in strict accordance with the ordinances of the City and the <br /> regulations of the State of Minnesota, and certifies that all statements made on this <br /> application are complete, true and �orrect. <br /> - F /� <br /> Signature of A�plicant: �'--�---- ' � Date: �� / � <br /> i , <br /> _ _ �. <br /> _ . . . Y�.. . . . . . . . . . . . .i'S: - <br /> ' i� . �t,�. � . . . , . � <br />