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��4, �_�`I <br /> � CITY OF ORONO APPLICATION FOR PLUMBING PERMIT <br /> r Box 66 (1335 So Brown Rd) <br /> Crystal Bay, MN 55323 <br /> *************************************************************************** <br /> 6eneral 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 yon receive a permit card. <br /> 4. Work must 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 must 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 /> *************************************************************************** <br /> JOB SITE ADDRESS: /30S Sl�[�'�tt�' �2 <br /> Occupancy Type: � Residential Commercial <br /> i OWNER'S NAME: $��/f �roP Phone No. : <br /> � Mailing Address: S�4m f �9S � City: <br /> , <br /> ' CONTRACTOR'S NAME: m��JtE �'�pKj�' ��[��f�f6� , � . Bu s. No. : 93/-9�n 7b� <br /> ; Mailing Address: /r,pS' f�t�l4�i£ So City: /,/p��;vs Zip: r�?;;�� <br /> Master Plumber's State License No. : /s/yrYl City Cert. No. : <br /> *************************************************************************** <br /> PLUMBING FIXTIIRE 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 /> _�----- --- ------ ------------- ---- ----�---- --------- ----- <br /> ------------- - -_T----- <br /> Water Closet _____ Sewer Ejector <br /> -------------�---- ,-- —---- - - ---- - ----------- -- ---•----- --------- ----- <br /> Lavatory � � __--__ Laundry Tray I ( <br /> -------------�-----�-------- -------- ----------- ---- ---•----- ---------+�----- <br /> Bathtub � + Washer � <br /> -------------�----� ------- -- --- ------ ------------- ---- --------- --------- ----- <br /> , <br /> Shower I � water Heater ' <br /> --------------�---- --�---- ----- ------ ------------ --- --•---- -------- I ----- <br /> � - - - - - - - - <br /> Ritchen Sink � 1 Water Softner <br /> ------------ --- � -�--- ------ ---- ----------- -- --�---- -------- ---- <br /> Disposal I_ Wet Bar <br /> -------------1 --- I ------ ----- ---- ----------- -- --�---- -------- ---- <br /> Dishwasher I- Sum Pum <br /> ------------ -1 --- --- - -------- ----- ---P----P--- --- ------- ---------- ----- <br /> Sillcocks Misc. (List) <br /> ------------- ----- ---•--- -------- ------ ------------- ---- ------- ---------- ----- <br /> Flaor Dr�ins Oi2V£IZ (�'�� �� 02 <br /> , <br /> -------------1----- ---�---- ---------1------1--------y----1----1--------J- ----L- <br /> *************************************************************************** <br /> 1. Fixture Fee The minimum permit fee is $30.00 $ �j/p,o0 <br /> Compute number of fixtures 5 x $8/fixture <br /> x $5/fixture reset <br /> 2. State Surcharge $ .50 <br /> 3. Postage � Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ y�,00 <br /> *************************************************************************** <br /> The undersigned hereby applies to the City of Orono for issuance 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 correct. <br /> ,-. .�--,,.,.,�. <br /> Signature of Applicant � ' Date: s/y-9'Z <br />