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CITY OF ORONO �,•p� APPLICATION FOR PLOMBING 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 pon receive a permi.t 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. A1 1 work must be inspected before it is covered. Call 473-7357. <br /> 24 honr notice reqnired. <br /> *************************************************************************** <br /> JOB SITE ADDRESS: .,2 � ���' S�. /1 � J� Lt <br /> Occupancy Type: ��Residential ' Commercial <br /> OWNER'S NAME: ��-.�, /�.4.�* /j�,`�� Phone No. : <br /> Mailing Address: �� 7 �r S,`/� ��,� �h City: �� �� <br /> CONTRACTOR'S NAME: � Bus. No. : ' ��2"r� <br /> Mailing Address: C'�4z� City: Zip:.�; `7 <br /> Master Plumber's State License No. : �+t, J1' fc/ v�Jc ;_ _ City Cert. No. : <br /> ***************************************�***�** e**************************** <br /> PLUI�ING FIXTIIRE SCHEDOLE <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 /> ------------- --�---- ---T----- ------ ------------- ---- ----�----- --------- ---- <br /> Water Closet / Sewer E ector <br /> _____________I=�__�________ ____ ____ ______ _______�_____ ____ ___._____ _________�_____ <br /> Lavatory � ( __--__ Laundry Tray <br /> ------------- ' ----�-------- -------- ---------- ---- ---•---- --------- ----- <br /> _ _ _ <br /> Bathtub ] � -__-- Washer <br /> ------------- ,-�=-�------- -- --- - ------------- ---- ---^--- --------- ----- <br /> Shower � , Water Heater <br /> -------------�-----�---•----- -------- ------ ------------- ---- ---•----- --------- ----- <br /> � <br /> Kitchen Sink f 1 Water Softner <br /> -------------y---- � ----- ------ ----- ------------ ---- -------- --------- ---- <br /> Disposal � Wet Bar <br /> -------------1-----�----- ----- ---- ------------ -� ---.---- -------- ----- <br /> Dishwasher___�- Sum Pum <br /> --------- --- ---•-- ---- -- ----- --P----P---- -- ------- --------- ----- <br /> Sillcocks Misc. (List) <br /> Floor Drains <br /> *************************************************************************** <br /> l. Fixtnre Fee The minimum permit fee is $30.00 $ �� � C <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 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: '`��"� � ���C?�- Date: �- � V �,�, <br />