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{ <br /> F <br /> ..._..___ .._ ,.........., cax a lu�\.taxxvs+ i�V' �Lvl� t.ut'Ut.a t <br /> Box 66 (1335 Brown Road South ) � � �? �� <br /> Crystal Bay, MN 55323 r - � `_�� <br /> ****************************************************** � �************'; <br /> �General Znformation *� <br /> r ... �. �� r....,1 - "� ' ( <br /> ' 1. You may apply for plumbing permits by mail or in person at the City of ' . �"� �� :5 ,R� <br /> 2. Mailed in application are subject to the postage and handling fees shown bel Permit Cards will� ;i� <br /> be sent by return mail the same day the application is received. �� �w �i� <br /> 3. Permits are not valid until you receive a permit card. --�� ._;� <br /> 4. Work must not begin until the permit card ia posted on the job site. <br /> 5. Plumbing permitsmay beissued to state-licensed plumbers or to homeowner/occupanta w o <br /> actually perform their own work in their home. <br /> 6. When any new construction or remodeling is involved, a separate building permit must be obtained. <br /> 7. All work must be done in accordance with the State Building Code Requirements. <br /> 8. All work must be inspected before it is covered. Call for inspections 24 hours in advance <br /> (473-7357). <br /> Instructions. Complete all items on this application. Compute the permit fee. Sign and date the ' <br /> certification. Zncomplete applications will not be processed. If you have any questions, call <br /> 473-7357. <br /> WALK-IN PERMITS--Apply at City Offices, 1335 Brown Road So. (County Rd 146) i <br /> MAIL-IN PERMITS--Enclose Fee--Mail to: P.O. Box 66, Crystal Bay, MN 55323 <br /> �t�k*******************************�t***�F****�k**�Ir**********�k***************** <br /> JOB SITE ADDRESS �/�(f'�% �L-�,-�,x���., �� <br /> Occupancy Type: �/" Residential Commercial <br /> Work to be Performed by: Licensed Contractor Owner/Occupant <br /> OWNER'S NAME ,��li/�'����� - ����Q�,,�jv,�'•, Telephone No. <br /> Mailing Address <br /> PLUMBER'S COMPANY NAME � l' � i`� � ! Bu s i n e s s No. � '� ` <��-'t�� <br /> Mailing Address � , � „ S' � <br /> Master Plumber ' s State License No.���J/�'�� City Cert. No. <br /> **************************************�* ********************************* <br /> PLUMBING FIXTURE SCHEDIILE <br /> (Show Number of Fixtures of Each Type on Each Floor ) <br /> FZXTURE TYPE BSMT. lst Floor 2nd Floor Other Floors FIXTURE TYPE � BSPIT. lst Floor 2nd F1oor � Other Floors <br /> Water Closet / Laundrv Tra <br /> Lavatorv Wa�sher � <br /> Bathtub , � _ Water Heater <br /> Shower � Watec Softne� � <br /> Kitchen Sink _� _ Misc. Fixtuzes: j <br /> Dis�osal (List) � <br /> Dis:;•«as.`.er <br /> wet Bar <br /> ` Sillcocks <br /> F1oor Drains I <br /> Sum Pumo <br /> Sewer Eiectoz I TOTAL VUMBER OF F2XTURES <br /> 7k**�F*7k�k***�k****�Ir7k*�k7k***ir*****7k*7k1F******'*7k7k�k*7k7k***1F�k�k*7k7k****7k*7tiF�t***7k***�k7k7k <br /> PERMIT FEE CALCULATION <br /> l . Fixture Fee. The minimum permit,. fee is $25 . 00 . , / C�' <br /> Compute number of fixtures _� x $4/fixture $ �S <br /> 2 . State Surcharge $ , �p <br /> 3. Postage and Handling (Only for Mail-in applications) $ 1. 50 <br /> �� <br /> 4 . TOTAL Permit Fee (Add lines 1-3 above) $ - � <br /> ************************************************************************** <br /> The undersigned hereby applies to the City of Orono for issuance of a PLUMBING PERMIT, agrees to do all � <br /> work in strict accordance with the ordinances of the City and the regulations of the Minnesota state <br /> Building Code, anc� certifi that all sta ements made on this application are complete, true and <br /> correct� .: <br /> , . �� � .� /�''���;�/'.�', '>: <br /> Signature Applic ate <br /> i <br />