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CITY OF ORCNO 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 /> Pe--*,iit 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 /> ********************************,*r****************************************** <br /> JOB SITE ADDRESS: Z-10 �"k 4=C I It 121-A <br /> Occupancy Type: Residential Commercial <br /> OWNER'S NAME: Lok Phone No. : <br /> Mailing Address: ,_yam yn.iC,�]. City: 1-.or.r� <br /> CONTRACTOR'S NAME: ,z_,` f - Bus. No. : <br /> Mailing Address: ►;� �> t>v``. tije City: S, ;.� f Zip: -;C11 <br /> Master Plumber's State License No. 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 1ST FLOOR 2ND FLOOR OTHER <br /> i <br /> Water Closet I Sewer Ejector j <br /> Lavatory <br /> ------- -- Laundry Tray <br /> ------------------ - = �----- ------ - ' ---�-------- ---------L- <br /> ------------ ---- <br /> Bathtub ( Washer <br /> -------------+---- I ------- -- --- ------ ------------ ---�--- --- ---------r----- <br /> , <br /> Shower J i Water Heater <br /> ------____-- _--- -- -- -- ------ -------------=----I -•----- ---------L___-- <br /> ___ _ _ <br /> Kitchen Sink Water Softner :, <br /> Disposal-----y---- I ----- ----- ------ ----Bar--------- <br /> ---- Wet-Bar------ ---- ------- I ---------I ----- <br /> Dishwasher -- Sumo FllIRD <br /> 1 <br /> -------------s---- ' - - ---1--- ---- ---- ---_----_---- ---- ------- ---------- ----- <br /> Sillcocks i I Misc. (List) <br /> ------ ----------a` ---- ------- - ------ ----- <br /> Floor Drains <br /> 1. Fixture Fee The minimum permit fee is $30.00 <br /> Compute number of fixtures x $5/fixture <br /> x $3/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 /> 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:— <br />