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ao�c� <br /> , ' CITY OF ORONO APPLICl�TION 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 muat <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 reqnired. <br /> *************************************************************************** <br /> JOB SITE ADDRESS: //Gs �iv� � 7--i� /�i.' � <br /> Occupancy Type: � Residential Commercial <br /> OWNER'S NAME: TfI�yIF S f rS/< Phone No. : <br /> Mailing Address: City: <br /> CONTRACTOR'S NAME: ��:�r..->.S C�-t' z�_ ` /,�.�.:�.���.�Bus. No. : `� �`/c " �i Z �% "7 <br /> Mailing Address: 5 y�2 � �7 ,�,Gti�.�� ,�2 _ City: t_ x <<���,�Q Zip: �,� <br /> Master Plumber's State License No. : 2 �z y�,.y� 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 /> ________�__'� �__ -1�__�� ��_T_____ ______ �����_�______ ____ _��'�._��� ��__����� _�___ <br /> F7ater Closet J Sewer E ector <br /> ------------- ---- ---�--- ---�-- ---- ------�---- -- --•---- ------- ---- <br /> Lavatory � � Laundry Tray <br /> Bathtub / Washer <br /> Shower Water Heater <br /> Kitchen Sink ' ____-- Water Softner s <br /> -------------�---- --�----- -------- ------------- ---- ---�---- - - ---- ----- <br /> Disposal I_ Wet Bar <br /> -------------1 --- ---- ----- ---- ----------- -- --�---- -------- ---- <br /> Dishwasher___�_ Sum Pum <br /> --------- --- ------ ------ ---- --P----P--- -- ------ -------- ---- <br /> Sillcocks Misc. (List) <br /> Floor Drains <br /> ������������� ����� ���i���� ��������� ������ ������������� ���� ���.����� ���������� ����� <br /> � �"�f 7t74'A'�'7k***'A"k**'k 7�'*�f'k*I�"k 7t'k**�f*7�*7t*******7t*******'k'k**�"k 7t**�C*'k*'k'k**I�"A'*'k*'A"k*'k*7t'k ' <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 /> � 3. Postage & Handlinq (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 /> �M /r�.� �� ^ - � -// <br /> Signature of Applicant: r� -'-'� f Date: � � <br />�: . � a.. '� ''.�: <br /> :..., ,. . :; }. , . <br />