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!`ITY OF ORONO APPLICATION FOR PLUI�IDING PSRMIT <br /> `� �.�c 66 (1335 So Brown Rd) <br /> �, Crystal Bay, MN 55323 <br /> *************************************************************************** <br /> General Instractions <br /> l. You may apply for plumbing permits by mail or in person at the City � ces. <br /> 2. Mailed in applications are subject to the postage and handlinq ho ow. <br /> Permit cards will be sent by return mail the same day the application d. <br /> 3. Permits are not valid until you receive a permit card. �On _` n� <br /> 4. Work must not begin unless the permit carc�, is available on the job site. �f�� U <br /> 5. Plumbing permits may be issued to licensed contractors only. ��j, <br /> 6. When any new construction or remodeling is involved, a separate 1'![��ding permit must <br /> be obtained. +�t � <br /> 7. All work must be done in accordance with State Code requirements. � ,� .(�, <br /> B. All work must be inspected before it is covered. Call 473-7357. 24 hour�`�otice <br /> required. <br /> *************************************************************************** <br /> Jos sz� AnnxEss: a��� ,���.o�rrz����s I(�� <br /> Occupancy Type: �Residential Commercial <br /> OWNER'S NAME: � � C�n--/�Yvl �2- Phone No. : � 3 S� �� 0 � <br /> Mailing Address: City: <br /> CONTRACTOR'S NAMR: �v�u����i. )�� �I u i��O�i�� G�� BuS. NO. : �f/o%`���Z_ <br /> Mailing Address: (p�,3�� ��;� ,,� �,?,o �, City: ��(2{-'� ��g/ <br /> Master Plumber's State License No. : i 7�c� City Cert. No- <br /> ****************************************** ******************************** <br /> PLUMBING FIXTQRE SCHEDDLE <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 /> Water Closet � ____ Laundry Tray l <br /> ------------ -�-- ---- -�--- - -------------- -------- ----- -------- ---- <br /> Lavatory t � Washer <br /> ------------ -1-- --!---- - -- ----- -------------- -------- ----- -------- ---- <br /> - - - - - ---- <br /> Bathtub /' � ___-_ Water Heater /, <br /> ------------ l-- ------- ------- ------------ ------- ----- -------- ---- <br /> Shower � Water Softner <br /> ------------- - --- --------- -------- ----- - -------- -------- ----- -------- ----- <br /> Ritchen Sink � Misc. (list) <br /> ------------- ----- --------- -------- ----- -------------- -------- ----- -------- ----- <br /> Disposal � <br /> ------------- ----- ---- --- -------- ---- -------------- -------- ----- -------- - <br /> Dishwasher � <br /> ------------- ----- --------- -------- ---- -------------- -------- ----- -------- ----- <br /> wet Bar <br /> ------------- ----- --------- -------- ---- -------------- -------- ----- -------- ----- <br /> Sillcocks � <br /> ------------- ----- --------- -------- ---- -------------- -------- ----- -------- ----- <br /> Floor Drains � <br /> Sump Pump � <br /> sewer Ejector <br /> *******************************� *****************************�************ <br /> 3 1. Fixture Fee The minimum permit fee is $30.00 $ ��_ a � <br /> � Compute number of fixtures x $4/fixture <br /> 2. State Surcharge $ .50 <br /> 3. Postage & Sandlinq (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT F$E (add lines 1-3 above) $ � � V <br /> *********************�********************************* ** **************** <br /> The undersigned hereby applies to the City of Orono for issuance of a Plumbing Permit, <br /> aqrees to do all work in atrict accordance with the ordinances of the City and the <br /> regulations of the State of Minne , a ce that all statements made on this <br /> application are complete, true _n e . <br /> _ —.._ - - ,-- -G� <br /> Signature of Applicant: Date: � `- C� <br />