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� C�TY OF ORCNO �PPLIC�TION FOR PLUMBING �ERMIT <br /> Box 66 (1335 So Brown Rd) �., � � <br /> Crystal Bay, MN 55323 . ,s� "� <br /> *****************************�r**��**************************************** <br /> General Instractions j� !°"V"�'"°"�-- <br />� 1. You may apply for plumbinq permits by mail or in person at the City f� 'ces. <br /> 2. Mailed in applications are subject to the postage and handling � shown belaw. <br /> Perr.iit cards will be sent by return mail the same da1 the application s 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 Iicensed contractors only. <br /> 6. when any new construction oz remodeling is involved, a separate buil��,s}� perm�it 7��t, <br /> be obtained. �i`� '�' <br />_ . _- ... 7. All work must be done in accordance with State Code requirements. <br /> 8. AI1 work must be inspected before it is covered. Call 473-7357. <br /> 24 honr notice reqnired. <br /> *****************************************�******************************** <br /> JOB SITE ADDRESS: ��1 � 'ri C ���!V" <br /> -.-. Occupancy Type: _� Resid ntial Commercial <br /> OWNER'S NAME-.-��.i-�.�,-�°,�-, �� Qk���c� >.r�-i c.r._ Phone No. : <br /> Mailing Addres s:��=;,'�� ,�?��-�,r A.�e r �.� City:�.t �_r. �•�_,�%c�a-��_ <br /> COidiic.a-,CTOR'S '.�.TAP''.E: � �- •�:..- -� 1, " `,� - :>. Bus. No. : "�J--�� 1� , <br /> , 4��,� <br /> Cit iM�r„-.�iv,�k�aa ZiF: '�,`.�. <br /> � � � Mailing Address: ���.L�-1+1 � "�'r,�l���-t ��,� g � Y= <br /> Master Plumber's State License No. : �� � 1�.� City Cert. No. : J <br /> *************************************************************************** <br /> - PLIIMBING FIXTIIRE SCHEDIILE <br /> � (Show number of fixtures of each tyFe on each floor) <br /> _ FIXTURE TYPE BSMT 1ST FLOQR 2ND FLOOR OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER <br /> --------—�--- -------—+----- T---- ------ ------------- --------- ----�— —--- <br /> S:ater Closet_� � I __ % r � Sewer Ejector j � <br /> ___________ 1____� s�__l___� ____I______ _____________�____ ___ _____ _________ _____ <br /> Lavator � �~ � � � Laundry Tray i <br /> y ---�-� --�-- --�---�------ ------------- ---- ---•----- ---------�----- <br /> --------- � � <br /> - � ' <br /> Bathtub i j � �� Washer � � <br /> ' ------------- -----------------�---- ------ --------------�---- ---r--- ---------r----- <br /> Shower I � ! I --_-__ Water Heater , �- �_ i <br /> ,... : ( � ' ------ ------------- --•----- --------�----- <br /> -------------�-----�--•------- ---- i <br /> � , + <br /> -. - _.: Ritchen Sink ' ' i Water Softner�__-I , i <br /> ---------'-----, --i----�--------------- ----------- � � 1��'.�=rc�l�_r -----'------ <br /> ---- � - --� <br /> i � <br /> IIisposal , _-___ Wet Bar l I <br /> -------------1---- -�--- ------- - ------------- ---- ---.--- �-----�----- <br /> --- <br /> � ; <br /> Dishwasher ` ' Sump Pump 1 <br /> � - <br /> -------------1-----�----•--- I--------- ------ ------------- ��- -�---�p ---------- ----- <br /> Sillcocks----� �-�---•---1--------- ------ Misc--(List�- ---- -- , _ <br /> 1 m�4_ a.1J=�F,,\ <br /> Floor_Drains-1-�---1--- �---�--------- ------ -------------1-'--l1�tY-�c�,�2¢,���"�_-----�----- <br /> - ie�tYe�t***x�tx�tz*�cie�tie�exi�i::'sx**ttt�**:k*ir*i�***�k�k***�k�t*******�t**�F*�F****,t,t****it*�ir*�F* <br /> l. Fizture Fee The minimum Fermit fee is $30.00 $^1(d�.�'� <br /> Compute number of fixtures � x $5/fixture <br /> x $3/fixture reset..,�?� <br />._^,...;,_ <br /> - 2. State Surcharge $ .50 , <br /> 3. Postage & Handling (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 /> , <br /> application are complete, true and correct. � i <br /> ' i <br /> �. . i <br /> . . ... � ���^ r'' Date: ��`�`7�! I` `i <br /> Signature of Applicant�I ,r�C-La y� �- � 'y�'��1 f <br /> ::; _ <br />