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'7l- J CITY OF ORONO APPLICATION FOR PLUMBING PERMIT Box 66 (1335 So Brown Rd) Crystal Bay, MN 55323 *************************************************************************** General Instructions 1. You may apply for plumbing permits by mail or in person at the City offices. 2. Mailed in applications are subject to the postage and handling fees shown below. Permit cards will be sent by return mail the same day the application is received. 3. Permits are not valid until you receive a permit card. 4. Work must not begin unless the permit card is available on the job site. 5. Plumbing permits may be issued to licensed contractors only. 6. When any new construction or remodeling is involved, a separate building permit must be obtained. 7. All work must be done in accordance with State Code requirements. 8. All work must be inspected before it is covered. Call 473-7357. 24 hour notice required. *************************************************************************** JOB SITE ADDRESS: Q25 U)y- Q- el. Occupancy Type: Residential Commercial OWNER'S NAME: b V(k Le, M,4A q Phone No. : _ 4-72-- 7410 Mailing Address: 13)_5 UIYlO. City: QrMo CONTRACTOR'S NAME: Uhoafn Bus. No. : Mailing Address: 0 City: _ mj-V_A_ Zip: j Master Plumber' s State Licen e No. : 1�vc� City Cert. No. : *************************************************************************** PLUMBING FIXTURE SCHEDULE (Show number of fixtures of each type on each floor) FIXTURE TYPE BSMT IST FLOOR 2ND FLOOR OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER Water Closet _----- Sewer Ejector -------- ---- ---—---- ----- ---- ------------- ---- ---••----- --------------- Lavatory ! i Laundry Tray ----------- _ _ � ------- ------ ------- ---- ---�•----- --------- ----- Bathtub Washer Shower ----_- Water Heater Kitchen Sink Water Softner I ------------- -----�------- ------------- ------------- --- -- ---- -------- ---- ----- - - --- - Disposal I- _--- Wet Bar -------- 1 ---- --—--- ------- ------------- ---- ---•---- --------- ----- Dishwasher __1_ _-_--- Sump Pump Sillcocks 1 Misc. (List) - ----- --- --- -- — ---- ------ ----------------- ---— -------------------- Floor DrainsL_ _____________ 1 . Fixture Fee The minimum permit fee is $30.00 $ 30 • W Compute number of fixtures x $5/fixture x $3/fixture reset 2. State Surcharge $ .50 3. Postage & Handling (Only mail-in applications) $ 1.50 4. TOTAL PERMIT FEE (add lines 1-3 above) $ �2 D The undersigned hereby applies to the City of Orono for issuance of a Plumbing Permit, agrees to do all work in strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements made on this application are complete, true and correct. Signature of Applicant: Date: