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, . � CITY OF ORONO APPI�ICATION FOR PI.UMBING PERMIT <br /> � . ,".Box 66 (1335 So Brown Rd) <br /> "' Crystal Bay, MN 55323 <br /> ********************************************************** <br /> General Znstrnctions <br /> 1. You may aFply for plumbing pe�-mits 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 yon receive a permit card. M AY 8 1991 <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 conered. Call 473-7357. <br /> 24 honr notice reqaired. <br /> *************************************************************************** <br /> JOB SITE ADDRESS: �Qp) �/a �i ,�'I�e)C��s� 2�/, <br /> � - Occupancy Type: ,�(. Resi ntial Commercial <br /> . OWNER'S NAM$�Y1�`� �C�{�e���r� Phone No. : <br /> -. Mailing Address: City: <br /> CONTRACTOR'S NAME��m 4xc�r��ux�l�ce, C��t� Bu s. No. : �c3�- 7'7/`7 <br /> � Mailing Address: I�nol 1���v��� R�ti City: �{-� Zip:SS;�� <br /> . Master Plumber's State License No. : M�'��,3 City Cert. No. : <br /> *************************************************************************** <br /> �• - � - PLDI�IDING 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 /> � ------------- ---� ----+----- ---�----- ------ ------------ ---- --------- --------- ----- <br /> V:ater_Closet_I �_=�__a--- -�•---- ------ Sewer_Ejector ---- ---•----- ---------�----- <br /> Lavatory � + � _�_ �_ Laundry Tray �-- �_ <br /> . � <br /> Bathtub-------�----�------- -�--- ------ Washer------- ---- ---�--- -------- I ---- <br /> Shower r � � Water Heater I -r_ <br /> -------------�-----�^--I----- -------- ------ ------------- ---- ---•----- --------- ----- <br /> _- -. Ritchen Sink � I Water Softner � _ <br /> ------------- -----�-- --- -------- ------ ------------- — -- ------- — --�-- �e�=�.�.� <br /> IIisposal-----1---- � -I-- ----- ---- Wet_Bar----- � --•---- -------- I ----- <br /> Dishwasher---�---- � - � -- --� -- ---- S�p-P�p---- �-- ----- --------- ----- <br /> . Sillcocks--- �- --•-- --�--- ----- Misc�_(Listl ---- � _ �� - - � ----- <br /> i� <br /> Floor_Drains- --�-- -- -- -------- ------ ------------- ---- a_�v.-M\-�`�--- ----- <br /> -�= - - <br /> � ******************************************************�********************* <br /> 1. Fizture Fee The minimum permit fee is $30.00 $ ,/�,5, (� <br /> Compute number of fixtures ��1 x $5/fixture <br /> � x $3/fixture reset <br /> - 2. State Surcharge $ .50 <br /> 3. Postage & Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERl�IIT FBE (add lines 1-3 above) $ l 10 /, (��. <br /> *************************************************************************** <br /> The undersigned hereby applies to the City of Orono for issuance of a Plumbing Permit, <br /> agrees to do all work in atrict accordance with the ordinancea 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 /> -:___ _, a /} <br /> .::: <br /> Signature of Applicant����� ���i�"��(/� _ _ Date: � �- 7/ -- <br />