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CITY OF ORONO APPLICATION FOR PLUMBING PERMIT <br /> Box 66 (1335 So Brown Rd) <br /> Crystal Bay, MN 55323 <br /> General Instructions <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 you 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 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 requirements. <br /> 8. All work must be inspected before it is covered. Call 473-7357. <br /> 24 hour notice required. <br /> *************************************************************************** <br /> JOB SITE ADDRESS: Com S TO so Q-0 C"-4- <br /> Occupancy Type: Residential Commercial <br /> OWNER'S NAME: A�.Pl1 K,c 1�'��F Phone No. : 47 <br /> Mailing Address: City: 1_4'1[..vZ��t+. <br /> CONTRACTOR'S NAME: Bus. No. : <br /> Mailing Address: City: Zip: <br /> Master Plumber' s State License No. : City Cert. No. : <br /> *************************************************************************** <br /> PLUMBING FIXTURE SCHEDULE <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 <br /> ____Water Closet Sewer Ejector <br /> =] _____ ___ l _ ____ ______-_-__ __ ___._-__ ____--___�_____ <br /> Lavatory ; ` Laundry Tray <br /> ------------- � ---+- <br /> ---- ----—---- ------ ------------- ---- ---•----- --------- ----- <br /> Bathtub Washer <br /> Shower , , Water Heater <br /> --------------------------------—--- ------ ------------- --- ---•--------------- ----- <br /> ---- --------- ----- <br /> Kitchen Sink ; Water Softner <br /> -------------�---- -------- ------ ------------- ---- -------- --------- ----- <br /> Disposal Wet Bar <br /> -------------1---- ---- ----- ---- ------------- --- ------- --------- ----- <br /> Dishwasher ---_-- Sump Pump <br /> -------------1---- --- -- ------ ---------- --- ------- ---------- ----- <br /> SillcocksMisc. (List) <br /> Floor Drains <br /> 1. Fixture Fee The minimum permit fee is $30.00 $ <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 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 /> application are complete, true and correct. <br /> Signature of Applicant: Date: 3�- 012 <br />