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CITY OF ORONO 1 � 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 must <br /> be obtained. <br /> 7. All work muat 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 required. <br /> **************************************************** ********************* <br /> JOB SITI3 ADDRESS: .J7 g�5 �� �� `��s�� <br /> Occupancy Type: Residential Commercial <br /> OWNER'S NAME: ��(�'d ����ti��� phone No. : <br /> Mailing Address: City: <br /> CONTRACTOR'S NAME: c Bu s. No. : ����/��� <br /> Mailing Address: � � City:6�+� Zip: � �S� <br /> Master Plumber's State License No. : , — City Cer No, : <br /> *************************************************************************** <br /> PLIIMBING FIXTURE SC$EDULE <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 Ejector <br /> ---- ---- ---�----- --------- ----- <br /> Lavatory Laundry Tray <br /> --- ---- ---•----- --------- ----- <br /> Bathtub Washer <br /> ------------- ----- ------- ------- ------ ------------- ---- ---------- --------- ----- <br /> Shower Water fIeater <br /> -------- ---- ---•----- --------- ----- <br /> Ritchen Sink I Water Softner <br /> -------------+----- --�----- -------- ------ ------------- ---- -------- -------- ---- <br /> Disposal Wet Bar <br /> -------------1----- --_--- ------- ------ ------------- --- ---.---- -------- ---- <br /> Dishwasher Sump Pump <br /> ---- ------- ---------- ----- <br /> Si11COCkS Misc. (List) <br /> ------------- ----- ---•--- --------- ------ ------------- ---- ------- --------- -- <br /> � --- <br /> Floor Drains ( • ' - _�,�;;� <br /> 4",�t j2 �Ct C c C�°� .�',C �F �/c• �,. �- <br /> ------------- ----- ---�---- ---��- ------ ------------- ---- -------- ---------- - <br /> *************************************************************************** <br /> 1. Fixture Fee The minimum permit fee is $30.00 $ <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 PBRMIT FEE (add lines 1-3 above) $ <br /> *************************************************************************** <br /> The undersigned hereby applies to the City of Orono for issuance of a Plumbing Permit, <br /> agreea to do all work in strict accordance with the ordinances of the City and the <br /> regulationa of the State of Minnesota, and certifies that all statements made on this <br /> application are complete, true and correct. <br /> ( c� <br /> Signature of Applicant: i Date: �� / / ` <br />