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i;ITI uk, URUNU 41kki#11;A11U" 1 UK YLUl�WIN U V hlmlY <br /> Box 66 (1335 So Brown Rd) <br /> Crystal Bay, MN 55323 <br /> *************************************************************************** <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 /> � q <br /> JOB SITE ADDRESS: /000 /[,;cw'aJ Li iJ t; ! Q <br /> Occupancy Type: Residential Commercial <br /> OWNER'S NAME: �_ n �� �, %O/y� Phone No. : <br /> Mailing Address: r� City: <br /> CONTRACTOR'S NAME: , �r"t.7 t - L�i� ^? — Bus. No. : <br /> Mailing Address: ,, City: kt,0) i!e P zip:_3__7 2F. <br /> Master Plumber's State License No. : 3Z City Cert. No. : <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 IST FLOOR 2ND FLOOR OTHER <br /> ------------- ---- ---.4----- P ----- ------ ------------- ---- ---- ---- --------- ----- <br /> Water Closet � Sewer Ejector <br /> -------------- ---- -- I ---- -----I------------ ---------------------------- ---------------- <br /> Lavatory --- �L� � l ----- Laundry Tray <br /> ------------ -+ ) ---- --------- - ------------- •----- --------- ----- <br /> Bathtub I Washer <br /> ------------- ----- ------- ----------------------------------- ---—--- --------- ----- <br /> Shower ( Water Heater <br /> Kitchen-Sink <br /> ----- �`_2� ��---- ------ <br /> Waterr <br /> ------- -1-- ------------------------ <br /> --- --------- ----- <br /> DisposalWet Bar <br /> ---------- ------ -------------- ---------------------------- --------- ----- <br /> Dishwasher --- - ' Sump Pump <br /> Sillcocks Misc. (List) <br /> Floor Drains <br /> —yy-------y----y— ----- ---i—y—yy—yy— --yy—yyayy---y-- yy------ -----y--y---yy—yy --- —y------y-- --------y-- -----y <br /> i.*�*•A•*i{•�•*a.�*********l{T T�'�'i..f ry*�*�•T��•***•k***�1.**R T!{F�***n*��n��******•�•F•k*�'k*i. <br /> 1. Fixture Fee The minimum perm fee is $30.00 $ 3� ' <br /> Compute number of fixtures x $8/fixture <br /> x $5/fixture reset <br /> 2. State Surcharge $ .50 <br /> 3. Postage i Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ 3 SSU <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 /> ^G�regulationa of the State of Minnesota, and c rtifies that all statements made on this <br /> I application are complete, true a correct. <br /> Signature of Applicant: `"t Dater/-/Z` �Z- <br />