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� T `�%� <br /> � CITY OF ORONO APPLICATION FOR PLUMBING PERMIT <br /> Box 66 (1335 So Brown Rd) <br /> Crystal Bay, MN 55323 <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 �nust <br /> be obtained. <br /> 7. All work muet 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 reqaired. <br /> *************************************************************************** <br /> JOB SITE ADDRESS: /�� J ,j�j'��'�"L//(>� ��'/�/�' <br /> Occupancy Type: Residential � Commercial <br /> OWNER'S NAME: Phone No. : <br /> Mailing Address: City: <br /> CONTRACTOR'S NAME: ��fG�/r' J�c���'���, Bu s. No. : L ��`�� ��.. <br /> Mailing Address: ����`.�`- �v��1� City:�o��4� � i�ipo � .�36�{ <br /> Master Plumber's State License No. : �,�,�v/�� City Cert. No. : <br /> ************************************ ************************************** <br /> PLUMBING FIXTURE SCHEDULE <br /> - (Show number of fixtures of each ty�e on each floor) <br /> FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER FIXTORE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER <br /> ------------- ---- ----+----- ----r----- ------ ------------- ---- --------- --------- ----- <br /> Water Closet j � Sewer Ejector <br /> ------------- ---- ---'C..---- ---- ---- ----- ------------ -- --�---- ------- ---- <br />� Lavatory -�- � Laundr Tra � / <br /> ------------- --- --- -------- ------ -----y----y -- --� --- ---i--- ---- <br /> Bathtub Washer <br /> ------------- ----- ------- ------- ------ ------------- ---- --------- --------- ----- <br /> Shower � Water Heater <br /> ------------- ---- --•----- --�--- ------ ------------ -- --�--- ------- ---- <br /> Ritchen Sink ' _ Water Softner <br /> -------------�----- -------- --�---- ----- ------------ -- ------- -------- ---- <br /> Disposal I_ ___-__ Wet Bar <br /> -------------1 --- ------ ------- ----------- -- --•---- -------- ---- <br /> Dishwasher I Sump Pump <br /> -------------1----- ---- -- -------- ------ ----------- -- ------ -------- ---- <br /> Sillcocks ___-__ Misc. (List) <br /> ------------- ----- --�--- --�---- ---------- -- ----- -------- ---- <br /> Floor Drains / <br /> ------------- ----- ---�---- --------- ------ ------------- ---- --------- ---------- ----- <br /> ***********************************,k*************************************** — <br /> l. Fixture Fee The minimum permit fee is $30.00 $ /�� '� L�' <br /> Compute number of fixtures � 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 PSRMIT FEE (add lines 1-3 above) $ f�,'<� ��C.% <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 /> Si nature of A licant: � � <br /> 9 FP � � Date: ` ' �o�- <br /> ■�, <br />