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CITY OF ORONO APPLICATION FOR PLUMBING PERMIT <br /> Box 66 (1335 So Brown Rd) ',(',� �j <br /> Crystal Bay, MN 55323 ( � <br /> ********************************�**************************************�*� <br /> General Instructions s <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 separtite 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: � 3 3 � /��r..�,1.-r.,� <br /> Occupancy Type: Residential ^,� Commercial <br /> OWNER'S NAM13: �.`� � ��z,T,.-i �-� Phone No. : <br /> Mailing Address: City: <br /> CONTRACTOR'S NAME: � I\, Bu s. o. : �/ � � � �� � � <br /> Mailing Address: / 2 � S� . " "' �, City: �_.�tn,,, -� Zip: s�.�� ) C� <br /> Master Plumber's State License No. : _3� '� 'Z Vv� � 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 /> ------------- ---- ----a----- ---�----- ------ ------------- ---- ----�---- --------- ----- <br /> Water Closet Sewer Ejector <br /> Lavatory � Laundry Tray <br /> Bathtub Washer <br /> ------------- -----�-------- ------- ------ ------------- ---- --------- --------- ----- <br /> Shower -___- Water Heater <br /> ------------- ----- --�----- ------- - ------------- --�- --•----- --------- ----- <br /> Ritchen Sink 'j � -_---_ Water Softner � <br /> -------------y---- ------- ------- ----------- -- •------ -------- ---- <br /> Disposal I_ Wet Bar <br /> Dishwasher---1 ---- ------- ------- ------ Sump Pump --- ---- -•--•---- --------- ----- <br /> -------------�---- ------- ------- ---- ----------- -- ----- ------ ---- <br /> Sillcocks � Misc. (List) � 3 �, ,�S <br /> ------------- ----- ---•--- --------- ------ ------------- ---- ------- --------- ----- <br /> Floor Drains I � <br /> ------------- ----- ---y---- --------- ------ ------------- ---- --------- ---------- - <br /> *************************************************************************** <br /> 1. 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 /> -., r <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 /> Signature of Applicant� �.�-� \l�-��1� Date: � � -- 3 -- `Tj <br />�� . „y . . . � � <br /> ���� ��,q. <br />