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�' , . <br /> , • CZTY OF ORC:IO �,PPLIC.�TICiJ �OR PLII.iBI.IG PER�'+�SIT <br /> Box 66 (1335 So Brcwn 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 /> Pesr,tit cards will be sent by return mail the same da1 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 remodelinq 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. All work must be inspected before it is covered. Call 473-7357. <br /> 24 honr notice reqnired. <br /> *************************************************************************** <br /> JOB SITE ADDRESS: p� / / ; � {`1 �c l �`� <br /> . Occupancy Type: Residential Commercial <br /> OWNER'S NAME: Phone No. : <br /> Mailing Address: City: <br /> CONTRACTOR'S NAME: S fL f Vl I� YGl C(S' Y��' /l�C' Bus. No. : C3- l�� <br /> Mailing Address: l Q� L{'C L�c City: �,c �-e 4iuY Z1F�SJ i 3/ <br /> Master Plumber's State License No. : ' City Cert. No. : <br /> *************************************************************************** <br /> - PLIIMBING FIXTIIRE SCHEDUI,� <br /> (Show number of fixtures of each tyFe on each f loor) <br /> FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER <br /> --�----- - - --------- -------- ---- <br /> ------------- _�----- -- <br /> --- <br /> �----i- r--- <br /> 6:ater Closet Sewer Ejector <br /> _____________!____� _______1__ l____I______I=====___-____�____ ___._____ _________ _____ <br /> i � � � Laundry Tray � � <br /> Lavatoryj —--- -------�------ ------------ --- I---•---------------� ----- <br /> ------------- '------- -I- __ Washer � _1_ � <br /> Bathtub � I � -- � -- --^----- -------- ----- <br /> Shower ------i-----I------ � -I----�------ Water-fieater-�----�---•----- ---------I ----- <br /> -------------�------- - - � - <br /> -•— <br /> - Ritchen Sink � I Water Softnerj I � <br /> ------------------ -------- -------------- ------------- ----�1--------- ---------I----- <br /> -I ,- i , <br /> Disposal Wet Bar � <br /> � <br /> � <br /> �------ --------+------ ------------- ---- ---•--- ---------�----- <br /> ------------- -----� I I <br /> i , • <br /> Dishwasher � Sump Fump � <br /> ' ---------*------ ------------- ---- ------- ---------- ----= <br /> -------------1-----�-------- . <br /> Sillcocks � ( Misc. (List) . <br /> � Floor Drains <br /> ---�---- --------- ------ ------------ <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 /> I � - 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 /> requlations of the State of Minnesota, and certifies that all statements made on this ; : <br /> application are complete, true and correct. � . <br /> - � <br /> . .... ~ Date: �-- / � � !� ?� ° <br /> Signature of Agplicant: � <br />:,b. <br />