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� <br /> CITY OF ORONO �PPLICATION FOR PLIIMBING PERMIT <br /> � , Box 66 (1335 So Brown Rd) <br /> Crystal Bay, MN 55323 <br /> *************************************************************************** <br /> General instrnctions <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 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 invol ved, 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: � � ��� -� � <br /> Occupancy Type: j�, Residentia Commercial <br /> OWNER'S NAME: � 7� Phone No. : <br /> Mailing Address: �� � � � City: � <br /> � - �/ �_ �, P- � <br /> CONTRACTOR'S NAME: ` � - �r, Bu s. o. • `f �.5 5 � y.� <br /> Mailing Address:� �' �i /',r ' ' � . City: Zip: S"�S� - <br /> Master Plumber's State License o. ^ � Cit Cert. No. : <br /> *************************************************************************** <br /> � PLUMBING FZXTIIRE SCHEDULE <br /> - (Show number of fixtures of each ty�e on each floor) <br /> FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER <br /> ------------- - -�----_ ---�----- ------ ------------- --__ ----^---- ------- <br /> _T---- <br /> ti:ater Closet I Sewer Ejector � <br /> ------------ 1--- �---—--- - ---- ------ ------------- -- ---�----- ---------I ----- <br /> -� i <br /> Lavatory � ; � Laundry Tray � <br /> ------------ � --- --—---- - ---- ------ ------------ ---- ---�----- ---------L----- <br /> 1----- I i <br /> Bathtub � j �_ Washer ( <br /> ------------- �------- - --- ------ ------------- -------- ---------� ----- <br /> , <br /> ---- - <br /> Shower _--___ (-----'�, I 4rater Heater _--__-- <br /> ------- --•----- -�---- ------ ------------- ---- --�----- i----- <br />� � ' - ! <br />:, ,-- Ritchen Sink ; � � Water Softner �, _- ! _____ <br /> ------------- ------------- ---------+------ -------------1---- --------- ------ -- <br /> Bisposal I � Wet Bar , <br /> -------------1---- � ----- ------- ------ ------------ ---- ---•---- ---------r----- <br /> ' ---------I <br /> Dishwasher � ' __-_-- Sump Pump <br /> -------------1-----}---- --- --------- ---------- ---- ------- - ----- <br /> SillCOCks Misc. (List) <br /> ------------- ----- ---•--- --------- ------ ------------ ---- ------- ---------- ----- <br /> Floor Drains _____ ��`==j��,�� ---- <br /> ------------- ----- ---�---- --------- - � -------- ----�----- ----- <br /> *************************************************************************** <br /> 1. Fixture Fee The minimum Fermit fee is $30.00 $ <br /> Compute number of fixtures x $5/fixture <br /> x $3/fixture reset <br /> - .?- <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) $ <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 /> , � � C� <br /> Signature of Agplicant: � � � �2i(/n� Date: � �J <br />