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� -� �� � �> <br /> , . , <br /> " CZTY OF ORC:IO APPLICATIO�I FOR PLUMBI�IG PEFtMIT <br /> .� Box 66 (1335 So Brown Rd) <br /> Crystal Bay, MN 55323 <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 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 pon receive a permi.t card. <br /> 4. Work must not begin unless the permit card is available on t�e 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 requireme /� <br /> 8. All work must be inspected before it is covered. Call 473-73��6 V ���� <br /> 24 honr notice reqnired. <br /> ********************,t******c*�r*************** ************,t**************** <br /> JOB SITE ADDRESS: C�^ c�l.t.0 �L?"� �L � <br /> - Occu�ancy Type: Residen 'al Commercial <br /> OWNER'S NAME: Phane No. : <br /> Mailing Address: r=}�'� <br /> CONTRACTOR'S NAME: v(`!� , �l,c i CQr Bus. No. : .� � <br /> Mailing Address: 5 o t� - '�:.-�c '� City: �IL�. Zip: � 3 j <br /> Master Plumber' s State License No. : �1�� City Cert. No. : <br /> .. *********************************************************************** *** <br />: , PLUMBING FIXTIIRE SCHEDIILE <br /> � (Show number of fixtures of each tyFe on each floor) <br /> FZXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTAER <br /> -------------T----_---�-----;---T----- ---- ------------- -- ----_---- -------j----- <br /> W.ater Closet � � I �___ __ �__Y�______ Sewer Ejector� j ____ <br /> �������������1����I�� � �������������� ���� ���'���������������i� <br /> Lavator ! ( � Laundry Tray � <br /> y , � �.. � � 1 � --1---------� <br /> Bathtub------�----i--—----i -�--- ------ Washer------- ---- --------- -------- ---- <br /> - =-------1- -- ------------- - -r- <br /> � �--I <br /> Shower -__-__ {__--_' � � � Tvater fieater � <br /> = ------- �� --�-------------�------ ----------------ttt�---- ---.----- ---------;----- <br /> � � � <br /> -.. : ._.�, Ritchen Sink - I I Water Softnerl � I <br /> - . ----------------------�-----i--------1------ --------------'----I---�----- ---------� ----- <br /> Disposal ' � '� Wet Bar � <br /> i � <br /> -------------1-----=-------- ------- ------ ------------- ---- ---�---- ---------�----- <br /> Dishwasher �I ' � Sump Pump + I <br /> � <br /> ' � <br /> ------__-_ 1____-�_------_ __'—�____ ______ _____________ ____ ___—r-- ______ 7 <br /> � <br /> .� Sl'l�.COCICS __- � � � I � . ^ � � 1 . ' • - =�__�_ <br /> "41�C. (L28t) _ �' iC.t- l <br /> ------------ ----- --�--- -------- ------ ------------- -�. - �--- --���- =� <br /> , _ - �iS��p��� � f(7.�.c�� ,�'��%,r�a r f�_. <br /> . Floor Drains 1 <br /> ---- ---�---- --------- ------ ------------- ---- --��At� -��'-'L-- ----- <br /> *************************************************************************** <br /> 1. Fixture Fee The minimum Fermit ee is $30.O1�r_ $ �`�S, � - <br /> Compute number of fixtures � x�5,(fixture .� <�Z� <br /> x $3/fixture reset <br /> � - ��� <br /> - 2. State Surcharge $ ` '"� <br /> , . � <br /> . . <br /> 3. Postage & Handling (Only mail-in applications) $ �.50 ) <br /> : . � _ ___ <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ �� � f ���-} <br /> *************************************************************************** <br /> The undersigned hereby applies to the City of Orono for issuance of a Plumbinq 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 /> application are complete, true and correct. � <br /> � Iz <br /> � }: <br /> Signature of Applicant:�.0 ���Y-/�.. _ Date: � l��C��- !�, <br /> ti <br />�. , <br />