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CITY OF ORONO APPLICATION FOR PLOI�ING P$RMIT <br /> Box 66 (1335 So Brown Rd) <br /> Crystal Bay, MN 55323 �� l¢ �l� �d ,�s�13 <br /> *************************************************************************** <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 aubject 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 must not begin unless the permit carc],,.is available on the job site. <br /> 5. Plumbinq 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. Al1 work must be done in accordance with State Code requirements. <br /> 8. All work must be inspected before it is covered. Call 473-7357. 24 hour notice <br /> required. <br /> ***************�************** ****************** ** ********************* <br /> JOB SITB ADDRBSS: ���7 �- L�O d� <br /> Occupancy Type: Residenti Commercial <br /> — <br /> owN�t�s vt�:,����i��*�-c� � ���hone No. : �7� -� ��.5 <br /> Mailing Address: � City: <br /> CONTRACTOR'S NAI�: � SO-� � . � Bu s. No : �,�.3�7/ <br /> Mailing Address: / City: � � <br /> Master Plumber's State License N . / City Cert. No. : <br /> *********************************** **********�**************************** <br /> PLOPIDING FIXTORB SCHEDULB <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 � <br /> LavatorY----- �=- -=�=- --�-- ----- -Washer------ -------- -�- -------- ----- <br /> Bathtub � Water Heater � <br /> ------------- - -- --------- -------- ----- -------------- -------- ----- -------- ----- <br /> Shower � � Water Softner <br /> Ritchen Sink- ----- ----�--- -------- ----- -Misc. (list)- -------- ----- -------- ----- <br /> ------------- ----- --------- -------- ---- -------------- -------- ----- -------- ----- <br /> Disposal � <br /> ------------- ----- --------- -------- ---- -------------- -------- ----- -------- ----- <br /> Dishwasher / <br /> ------------- ----- --------- -------- ---- -------------- -------- ----- -------- ----- <br /> Wet Bar � <br /> ------------- ----- --------- -------- ---- -------------- -------- ----- -------- ----- <br /> Sillcocks � <br /> ------------- ----- --------- -------- ---- -------------- -------- ----- -------- ----- <br /> Floor Drains I <br /> Sump Pump <br /> Sewer Ejector <br /> ******************************** ****************************************** <br /> l. Fixture Fee The minimum permit fee is $30.00 $ <br /> Compute number of fixtures x $4/fixture <br /> 2. State Surcharqe $ .50 <br /> 3. Postaqe b Handling (On1y mail-in applications) $ 1.50 <br /> 4. TOTAL PBRMIT FEE (add lines 1-3 above) $ <br /> *******,t******************************************************************* <br /> The undersigned hereby applies to the City of Orono for issuance of a Plumbinq Permit, <br /> aqrees to do all work in strfct accordance with the ordinances 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 /> — - -�- -. , <br /> ~ Signature of Applican : � . C/ � Date: /�f � <br />