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Crystal Bay. MN 55323 . •.**********************x*� <br /> ************************************************ 4�'.. <br /> General Instrncti.ons 1 <br /> 1. You may apply for plumbing permits by mail or in persan at the City�officea -� ;r� s <br /> 2. Mailed in applicationa are-subject to the postage and handling'���s_ehown?belo + i .�, <br /> return mail the same dav the applicati;�in is rec��;���'E�'�� <br /> Permit cards will be sent by �t carcl. � <br /> ! 3. per�3,ts are not valid uatil pon receive a pe r <br /> t�. . <br /> 4. Work must not begin unless the permit card is availat�le on the job site. _' <br /> 1 : 5. Plumbing permits may be issued to licensed contracto:_s only. e�it must �•. : <br /> JAN �`� <br /> 6, When any new construction or remodeling is involved, a separate building P 9 �991 ��' <br /> ' be obtained. re irements. �� <br /> � �, All work must be done in accordance with State Code qu _ _ ^ �.. <br /> i, <br /> � 8. All work must be inspected before it ia covered. Call 473-7357. , <br /> • 24 honr notice reqnired. � <br /> ' ************************************************�**��******************** �,: <br /> JOB SITE ADDRI3SS: � �Residenti�al ( ��.,u�rcial <br /> Occupancy Type: , <br /> Phone No. : <br /> OWNER'S NAME: C i t.y: , <br /> Mailing Address: ' <br /> Bns. No. : S�(�/'305 7 <br /> CONTRACTOR'S NAME: City: R�c-�.��P-Ic-�- Zip: 5S <br /> Mailing Address: �n�n�/� � �'%� S" ' <br /> � C�ty Cert. No. : ; <br /> Master Plumber's State License No. : � �s� � , <br /> *******************************�********************n*********************** �., <br /> pLUMBING FIXTOR$ SC�eLon each floor) <br /> (Show number of fixtures of each typ <br /> FIXTURE TYPE BSMT 15T FLOOR 2ND FLOOR OTHER_ FIXTURE-TYPE- BSMT 1ST FLOOR 2ND FLOOR OTHER . <br /> ------------- ---- ----a----- ---T----- - Sewer Ejector <br /> Water Cloaet- --�- ---'�`---- ----�---- ------ ------------- ---- ---�----- --------- ----- ' <br /> ----------- I . <br /> t � Laundry Tray <br /> Lavatory l � -""-"- ----- � <br /> ----- ---- <br /> ------- -------- <br /> -------- Washer , <br /> Bathtub � ------- <br /> ------- -- --- -- <br /> ------- ---- ---^--- - <br /> ------ ----- <br /> ------- � <br /> _-_-_ Water Heater <br /> Shower -'----- <br /> ------------- - <br /> ---- --•----- <br /> -------- - <br /> 1 Water softner __ <br /> Ritchen Sink - ------ ------------- ---�- --------- --- ----- --- <br /> ------------- ---- --�-- � -- Wet Bar I --------- ----- <br /> Disposal --�- ---•—"-- <br /> -- - --- <br /> ----------- - - <br /> Dishwasher ( --""---- � <br /> ------------ ---- ------- <br /> ----- ----•--- <br /> ---------- ------ S�P um ____ <br /> ---------�--- Misc. (List) <br /> Sillcocks '--'-----� <br /> Floor Drains -"-'-'--- - <br /> -1--- ---�=--- ---- ------ ------------- ---- ----- <br /> ***********************************************o***�******�*�****�****** <br /> 1. Fixture Fee The minimum permit fee is $3�.� <br /> Compute number of fixtures x $5/fixture <br /> x $3/fixture reset <br /> 4 .50 <br /> 2. State Surcharge - <br /> mail-in applications) $ 1.50 <br /> 3. Postage & Handlinq (Only - $ / / �` � <br /> � 4. TOTAL PBRMIT FB$ (add lines 1-3 above) <br /> 1 <br /> ****,t*********,t******************************************************Permit* <br /> The underaigned hereby applies to the City of Orono for issuance of a Plumbing <br /> agrees to do all work in ftMinnesotardand certifies thatiallcstatementsCmade ondthis <br /> regulations of the State o <br /> application are complete, true and co ect. <br /> r �/ <br /> ,� / <br /> ' Date: <br /> Signature of Applicant: _ <br /> ...._ .. . . . . � ' . -;P'.^ � . . � t�, '' <br />