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_ *�o z. <br /> , CITY OF ORONO APPI,ICATION FOR PLDMBING PERMIT , <br /> ��" Box 66 (1335 So Brown Rd) <br /> �' Crystal Bay, MN 55323 <br /> *************************************************************************** <br /> General Inatructions <br /> l. You may apply for plumbing permits by mail or in person at t�e.Gi-ty•,;offices.,' � � <br /> 2. Mailed in applicationa are sub ject to the poatage and ha 'dling fees ahown�elow. . <br /> Permit cards will be sent by return mail the same day the ap�lication is recei d. <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 conatruction or remodeling is involved, a separate bui�ding,{��cplit muet <br /> be obtained. ��N 1 •1•'�"� <br /> 7. All work muat be done in accordance with State Code requirements. _ _ _ , <br /> 8. All work must be inspected before it is covered. Call 473-7357. <br /> 24 honr notice reqnired. <br /> *************************************************************************** <br /> JOB SITE ADDRESS: //Q (,( G)pr(��� S �� �ZV, <br /> Occupancy Type: _� Reside ial Commercial <br /> OWNER'S NAME: �_,Q�,�, C,�(,(��Q �, Phone No. : <br /> Mailing Address: City: <br /> CONTRACTOR'S NAME: ��iOm�r���� CO-�.o Bu s. No. : ��-'"'��(rI <br /> Mailing Address: ISCx�\ 9_ City: ��'�{2e�, Zip:�� <br /> Master Plumber's State License No. : �M 1'"'��� City Cert. No. : <br /> *************************************************************************** <br /> PLUMBING FIXTURE 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 Cloaet i Sewer Ejector <br /> � -�---- -�•---- ------ ------------- ---- ---•----- --------- ----- <br /> ------------- ---- - <br /> Lavatory iaundry Tray / <br /> � ------------- -�- �---- -- 3-- ------ ------------- ---- ---.----- --------- ----- <br /> Bathtub------ ----- --�---- --�--- ----- Washer------- ---- -=^----- --------- ----- <br /> Shower � � Water Heater <br /> ------------- ----- --•----- --------- ------ ------------- �- ---•----- --------- ----- <br /> Ritchen Sink � Water Softner <br /> Disposal � ____Bar S►nl(r ' <br /> ------------- ----- ------ ------- ---- - - -- • <br /> Dishwasher � Sump Pump , <br /> Sillcocks---- -� - ----•--- -------- ------ Misc. (List)- ---- --�--�U iG�T-�{-- � <br /> Floor Drains _ " <br /> ------------- - --- ---�---- --------- ------ ------------- ---- -- - ----- <br /> ***************************************************** *��` ***** - --. <br /> 1. Fixture Fee The minimum permit fee is $30.00 $_�fz ('X� <br /> Compute number of fixtures � x .$8/fixture <br /> x $5/fixture reset , <br /> 2. State Surcharge $ .50 <br /> 3. Postage � Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PBRMIT FE$ (add lines 1-3 above) $ o�90•�d <br /> *************************************************************************** <br /> The undersigned hereby applies to the City of Orono for issuance of a Plumbing Permit, <br /> agrees to do all work in atrict accordance with the ordinances of the City and the <br /> regulations of the State of Dfinnesota, and certifiea that all statements made on this <br /> application are complete, true and correct. <br /> Signature of A�plicant�iGG�� (.�1._L�'vr,�� Date: �p�'8-'9� <br />