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CITY OF ORCNO APPLICATION FOR PLU2BING 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 recruirements. 8. All work must be inspected before it is covered. Call 473-7357. 24 hour notice required. JOB SITE ADDRESS: ), 10 VJ 0"i.., E_ C'> F 0-=i Occupancy Type: Residential Commercial t� OWNER'S NAME: 0 ua �"' _ Phone No. . r1 1 Z,)C� Mailing Address: ` V�_-V City: [ n.a CONTRACTOR'S NAME: �(�t F-�I � 8Us.� No. : - 1 2,S Mailing Address: City: Zip: Master Plumber' s State License No. : City Cert. No. : PLUMBING FIXTURE SCHEDULE (Show number cf fixtures of each type on each floor) FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER -------------7--- ----- --- - ----^---- ---- ----- T----- - r P:ater Closet I ---- Sewer Ejectors _-- i _____________ -- ____i____ I_----- _____________ _ ------------------------- Laundry __._-___ ___-__________- Lavatory---- --- ' -------I - ---1------Laundry---al- �--- ' -- ----- ---------I ----- _ _ _ Bathtub I j I � Washer _1_ i -----------=-------y-- - ------ ------------- I--- � ------- ---------r----- Shower i Water Heater ------------- i-------- -------------------- -------------------------- - Water - --------i----- Kitchen Sink i ------------i---- 1-------- ---------I----- -------------- -- ------------7-- ----------- - Disoosal IWet Bar -------------y---- ----- ------- ----- ----+------- ---------�------ - Dishwasher ! Sump-----Fu------- ---- --- mp 1 -- ---- ------ ---_----_---- --- - ---------------- Sillcocks ----� Misc (List) Floor Drains -------------1---- --- ---1- ------------- -----�-------- --------- ------ ------------- ---- -------- ---------- ----- 1. Fixture Fee The minimum permit fee is $30.00 $ Compute number of fixtures 1 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) $ *************************************************************************** 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 orr t. Date: Signature of Applicant:;