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CITY OF ORONO APPLICATION FOR PLUMBING PERMIT <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 /> JOB SITE ADDRESS: Uj-,de -�� <br /> Occupancy Type: X Residential Commercial <br /> OWNER'S NAME: e be t JV�bieiC- Phone No. : <br /> Mailing Address: City: <br /> CONTRACTOR'S NAME: / 1Y) I �i Bus. No. : 91-15 U <br /> Mailing Address: , u J �Q City: r7kI��:C c u Zip: "g 1? <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 /> -------+--------- - ---- ----^---- ------- <br /> Water Closet �( ri- �- Sewer Ejector- <br /> ------------ u ,---—---- - -- ----- ------------- --- --- -----r---------^----- <br /> j Laundry Tray <br /> Lavatory �© <br /> ----- ------—--- --- --- ------- ----------------- --- ----- --------- ----- <br /> Bathtub I - j Washer <br /> ---------- <br /> ----�-- -- ---- --- --- ------ --------------f---- --- -------------- <br /> Shower <br /> -- --------- ----- <br /> Water Heater I ` <br /> Shower------ ! `-- ---- ------ ------ ------------ 1 - ---•----- ---------I----- <br /> ------ --- ''- <br /> Ritchen Sink ' Water Softnerl I- <br /> - , I 1 <br /> --------------- <br /> -------•-----7------- ------+-------------�---- ---- ------ =----- <br /> Disposal I f Wet Bar <br /> --------- ----- <br /> Dishwasher --------� <br /> -- <br /> --1 ------ ------- ------ ------------- ---- ------- - ----- <br /> ' <br /> Sumo Pump <br /> SillcocksMisc. (List) <br /> ------------ 1I-- -I�--- --- --------- ------ ------------ ---- ------- ---------- ----- <br /> Floor Drains 1- 1- <br /> *�k**.k*******ic***************•kir*******************yr**ie***ir****************** <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 /> *************************************************************************** <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 /> r <br /> Signature of Applicant: 4L.- Date: � <br />