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i <br /> i CITY OF ORONO APPLICATION FOR PLUMBING 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 �ity� offices. <br /> 2. Mailed in applications are subject to the post.age and handlinq fees shown below. <br /> ,' Permit cards will be sent b�i return mail the same day the application is receiv��p� <br /> 3. Persits are not valid until pon receive a perait card. A O <br /> ' 4. Work must not begin unless the permit card is available on the job s�. Y <br /> � 5. Plumbing permita may be issued to licensed contractora only. �� <br /> � 6. When any new construction or remodeling is involved, a separate building permit must <br /> ! be obtained. <br /> i 7. Al1 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: �/�G - � �'f' ,C.C��'�//LtiL� �`�zZ��1i� <br /> Occupancy Type: x Residential Commercial <br /> OWNER'S NAMB: Q�(�u� /��e�, Phone No. : <br /> Mailing Address: j�' City: ��p� � , � <br /> CONTRACTOR'S NAME s,��Z J o x�,A�� , Bu s. N : .��~7��� <br /> Mailing Address: / Op C � City: Zip:_S_S� <br /> Master Plumber's, State License o. : /7l0 3/7� City Cert. No. : <br /> *********************s************************************,r**************** <br /> PLOI�ING FIXTORE SCHEDUL$ <br /> (Show number of fixtures of each type on each floor) <br /> FIXTURE TYPE BSMT 1ST FI,OOR 2ND FLOOR OTHER FIXTURE TYPS BSMT 1ST FLOOR 2ND FLOOR OTHER <br /> � ------------- ---- ---�----- ---T----- ------ ------------- --- ---�---- --------- ----- <br /> water Cloaet / � sewer Ejector ` , ' <br /> ------------- ---- -- ---- ----•---- ----- ------------ -- --�1--- ------- ---- <br /> Lavatory � ' ,r� Laundry Tray / <br /> ------------- --- -- --- ---^---- ------ ------------ -- --� - ------- ---- <br /> Bathtub � Washer / �- - - - - <br /> ------------- ----- ------- -- --- ------ ----------- -- -r� -- ------- ---- <br /> Shower � ��, Water Heater � <br /> ------------- ---- -�—'---- ------- ----- ------------ -- --• - ------- ---- <br /> Ritchen Sink �i Water Softner <br /> ------------- ----- --�---- -------- ------ ------------- ---- ---�----- --------- ----- <br /> Disposal � Wet Bar i <br /> � <br /> ------------- ----- ------- ------- ------ ------------- ---- ---•--- --------- ----- <br /> Dishwasher � Sum pum � <br /> P P <br /> ------------- ----- -/•--- --------- ------ ----------- -- - ---- -------- ---- <br /> Sillcocks � Mise. (List) � <br /> Floor Drains / ' <br /> ------------- ----- ---+=--- --------- ------ ------------- ---- -------- ---------- ----- <br /> *************************************************************************** <br /> 1. Fixture Fee The minimum permit fee is $30.00 $ /�j�S; G� � <br /> Compute number of fixtures � x $5/fixture <br /> x $3/fixture reset <br /> 2. State Surcharge $ .50 <br /> 3. Postage � Handlinq (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FE$ (add lines 1-3 above) $ /O � O� <br /> *************************************************************************** <br /> The undersigned hereby applies to the City of Orono for isauance of a Plumbing Permit, <br /> agreea to do all work in atrict accordance with the ordinances of, the City and the <br /> requlations of the State of Minnesota, and certifies that all statements made on this <br /> application are complete, true and correct. <br /> �� -�— ` � <br /> Signature of Applicant: �-.i'-`!'��� ��� ���'`�Date: J . <br />