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�� ' CITY OF ORONO APPLICATION FOR PLUMBING PERMIT <br /> Box 66 (1335 So Brown-,Rd�=-, <br /> Crystal Bay, MN 55323� � � Q <br /> ***********************************************************�**�*�r********** <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 handlinq 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. <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 sep �b�rildi_n�-�i�,�t must <br /> . be obtained. ��� � ' <br /> � � : : <br /> , ... 7. Al l work must be done in accordance with State Code require �nts. _ ;<,.;l <br /> 8. All work must be inspected before it is covered. Cal 1 473-7357: <br /> 24 honr notice reqnired. <br /> ******,t******,t*,t******,t,t******,t****************************,t*************** <br /> JOB SITB ADDRESS: O�((X�� o�(,C GlQ Y-L t�C�p c'�� <br /> - Occupancy Type: �_Residenti Commercial �, 1 <br /> OWNER'S NAMB: Phone No. : , g~ ' � �-- - <br /> Mailinq Address: City: <br /> CONTRACTOR'S NAME:��nm�����nr����o. ��'� Bus. No. : �� -`�� _ <br /> Mailing Address: ��c�n4 M-�kn .�r,rl,����r-i�.e 2 City: t�h-l-kc�. Zip: <br /> � Master Plumber's State License No. : �11�'1le'� City Cert. No. : � <br /> - ***********************************,t*************************************** <br /> �- " PLIIMBING FIXTIIRE SCHEDIILE <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 /> h'ater_Closet-�----�------- --- ---- ------ Sewer-Ejector --- ---•----- ---------�----- <br /> . � - - - <br /> Lavatory � ; Laundry Tray <br /> Bathtub -----�----;-------- -------- ------ Washer------- ---- -- -- -��---I ----- <br /> Shower -------�----�------- -- --- ------ Water Heater- ---- ---^----- --,I��---- <br /> - . -------------�----` --�----- -------- ------ ------------- ---- ---.- -- ---- = 4 - <br /> : ',-=• Ritchen Sink � + I Water Softner <br /> -------------------�--�----- -------- ------ ------------- ---- -------- ---�-�j�-- - <br /> Disposal � Wet Bar � �� <br /> -------------1---- ---- ----- ------ ------------ -- ---.----- �----- ---- <br /> Dishwasher---�- - - - - - Sump Pump - - - - -- <br /> . Sillcocks Misc. (List) <br /> Floor Draina <br /> ------------- ----- ----=--- --------- ------ ------------- ---- -------- ---------- ----- <br /> ****************************************** **************************** <br /> 1. Fisture Fee The minimum permit fee i $30.0 $ �� �CX'� <br /> Compute number of fixtures x $5/fi <br /> � " x $3/fixture reset <br /> 2. State Surcharge $ .50 <br /> 3. Postage & Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL P$RMIT FBE (add lines 1-3 above) $ C )c�.�'Y� <br /> ********************************************************* ** ************* <br /> The undersigned hereby applies to the City of Orono for issuance of a Plumbinq Permit, <br /> agrees to do all work in atrict 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 /> Signature of Applicant��i-�ie�/,� C1��� Date: � -o�� "�� <br />