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CITY OF ORONO r�PPLICATION FOR PLUMBING PERMIT <br /> Box 6 6 (13 3 5 So Brown Rd) ., �- - <br /> . Crystal Bay, MN 55323 � �JJ� 7 2- <br /> *************************************************************************** <br /> General Instractions <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 da1 the application is received. <br /> 3. Permits are not valid uatil yan zeceive a permit cszd. <br /> 4. Work must not beqin 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 construction or remodeling is involved, a separate building permit must <br /> be obtained. <br /> . �-.. 7. All work muat be done in accordance with State Code requirements. <br /> � 8. AlI work must be inspected before it is covered. Call 473-7357. <br /> . 24 hour notice reqaired. _ . _ _ __ <br /> ***,r***,t***,t********,t*,t***,t************************************************ <br /> JOB SITE ADDRESS: 21�2 ���- W�-S ��- <br /> . . Occupancy Type: �_Residential Commercial - <br /> M1 OWNER'S NAI�D:: �L'A`� ��� Phone No. : <br /> � � � Mailing Address: City: <br /> ' CONTRACTOR'S NAME: 1`�ly 1�IO�rTN ���uaf�� sus. No. : �'3-2�17� <br /> � � Mailing Address: Q2A0 __ City: 1� fsi��vc Zip:� <br /> Master Plumber's State License No. : ?,pb City Cert. No. : <br /> � *********************************************************************,r***** <br /> ._����", PLIIMBING FIXTORE SCHEDUL$ <br /> (Show number of fixtures of each tyFe on each f loor) <br /> ' FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER <br /> . � -------------T---- ---+----- ---�----- ------ -------�----- ---- ----�---- -------- -- <br /> - - <br /> � k'ater Closet 1- � � Z Sewer E ector I <br /> _____________ ___�________ ____.____I______ _____________ ____ ___._____ _________�_____ <br /> � Lavatory � � � 4 _ Laundry Tray � <br /> Bathtub------j---- I -------y-- �--- ------ Washer------- ---- ---------- ---------I ----- <br /> � � <br /> .� - ; -` � ' Z- <br /> Shower I � Water Heater ` <br /> ------------ -------•---- I------- ------ ------------- ---- ---•----- --------- ----- <br /> - -�- ' - <br /> , + i � <br /> ..�:;�.;_:; Ritchen Sink ; Water Softner <br /> Disposal-----1---- + -�--- ------ ------ Wet_Baz------ ---- ---•�-- --------- ----- <br /> � Sum Pum <br /> Dishwasher �I I � <br /> -------------1----- ----•-- -------- ----- ---P----p---- ---- ------- ---------- ----- <br /> : � - - <br /> =� Sillcocks 3 Misc. (List) � �� n'1 ti� ^ <br /> .. .. ------------ ---- --•--- -------- ------ ------------- ---- ------- ---------- ----- t <br /> . �. Floor Drains � � <br /> ------------- ----- ---�=--- --------- ------ ------------- ---- -------- ---------- ----- <br /> • -• *********************************,r***************************************** <br /> 1. Fiatnre Fee The minimum permit fee is $30.00 $ <br /> - Compute number of fixtures x $5/fixture <br /> � - x $3/fixture reset <br /> ;':;;,;� <br /> � 2. State Surcharqe $ .50 <br /> � " 3. Postage & Handlinq (Only mail-in applications) $ 1.50 <br /> . � 4. TOTAL PBRMIT FE$ (add lines 1-3 above) $ � <br /> . . ********************************�****************************************** <br /> The undersiqned hereby applies to the City of Orono for issuance of a Plumbinq Permit, <br /> . agreea to do all work in strict accordance with the ordinances of the City and the <br /> ^ ragulationa of the State of Minnesota, and certifies that all atatements made on this <br /> application are complete, true and correct. <br /> _ _ - <br /> _ <br /> ; _- _ _ __ _ <br /> _ _ <br /> �.. :_ _ _ _ ___- - �J� <br /> _. __ _ _ e <br /> _ � _ Date: __ <br /> �� � � Signature of Applicant: - <br />