|
CITY OF GROW APPLICAT:=01* I PLUMBING PERMIT
<br /> Box 66 (1335 So Brown Rd)
<br /> Crystal Bay, MN 55323
<br /> VP, ***************************************************************************
<br /> General Instructions
<br /> ...
<br /> I. You may apply for plumbing permits by mail or Ii01arSon at the City offices.
<br /> ...
<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 /> ************************************************1**********qe**************
<br /> JOB SITE ADDRESS: .235D Cr.)#s-t• Wtity1e1-41-a. Bit/at -
<br /> Occupancy Type: Residential 6--- Commercial
<br /> OWNER'S NAME: 04k-in e)rOfink rS Phone No. :
<br /> •• i
<br /> • Mailing Address: 4021,4_.., City: p
<br /> ,
<br /> ,... -
<br /> CONTRACTOR'S NAME: AH Ltd. Bus. No. : $92-377Q
<br /> Mailing Address: / ervii„.201) city:aurnsziak zip: 53337 •
<br /> -..
<br /> .--,, Master Plumber's State License No. : City Cert. No. :
<br /> ***************************** *******************************************
<br /> < ‘.
<br /> PLUM'ziNG FIXTURE SCHEDULE •
<br /> (Show number of fixtures of each type on each floor)
<br /> FIXTURE TYPE BSMT 1ST FLOOR 2ND FP'TP OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER
<br /> . iI 4-- r- --r
<br /> r
<br /> Water Closet ,2_ ,
<br /> ,.,„; . Sewer Ejector .,
<br /> ,:.
<br /> 3 ,
<br /> Lavatory 1 ;:. Laundry„ Tray •
<br /> - . — - - .
<br /> .,
<br /> - ' Washer
<br /> Bathtub
<br /> Water Heater , s
<br /> =
<br /> ______, . .
<br /> ..... ... 4 .4.4~
<br /> i
<br /> Shower
<br /> j - - - I
<br /> ' 1 i - .. • 4
<br /> Kitchen Sink 1 1 .,.. Water Softner
<br /> Disposal Wet---------------------------------- -
<br /> 1 I
<br /> , -- Bar • - -
<br /> _
<br /> Dishwasher , .
<br /> • Bump Pm”
<br /> Sillcocks
<br /> j - misc. (List)
<br /> Floor Drains
<br /> - .
<br /> .
<br /> ************************************.******** **************************** ;
<br /> 0•
<br /> 1. Fixture Fee The4/ 0 0
<br /> minimum permit fee id430:1)(r1r,
<br /> tA,.41" - 0 .•
<br /> •I4 Compute number of fixtures — x $5/fixture %,77m-',.
<br /> — x $3/fixture 'least
<br /> = ,,'- -
<br /> 2. State Surcharge 4:4. -11.,fV ": 4 --- f •50 - -'''
<br /> ett .4 -4 ............... .., 1:i.,';'''"1 •,•,•)..:•-.
<br /> . '" - '''*A., ' ' if. ' ‘ ' ., • •. vit,.;"-;`47-;11 ze 4";
<br /> ,
<br /> '-... „ 3. Postage I Handling (Only mail- pp i
<br /> tme)
<br /> I -.* -- - 1 50
<br /> *171,.44g*'
<br /> 4. TOTAL PERMIT FEE (add lines 1-3 abovs,14f qa .ao 4. --,:,-:-,_
<br /> ::-,t-lr,s4
<br /> • 15C
<br /> The undersigned hereby applies to the -CiW:aliktlieitrelitifiSnce of a Plumbing Pervait,"'z--
<br /> , . ,, • .:„,
<br /> agrees to do all work in strict accr.rdanciazfith0,670,rdfnance of he City and the Iii••-:;;•„_'''4,',4„- ;4
<br /> .- . ., .
<br /> requlatiorke of the State of Minneeota, mini .-C•rtiiioil- hat 11 ett• rrerts made on this ,7.4..;14,t',
<br /> application are complete, true andr.--
<br /> '
<br /> . ---.., -- .. ,, '
<br /> _.,z,i_ ...., I.,_..4,-,. :..4,,,,,, ,..t, l'1,
<br /> ,•••,J.:- - '''—••-••.:.' .. r..;, -&-%',.scP4N).`. '‘1,..
<br /> •,-" '. . .' '. .-- ,..., 1/41-.-,-.“.,,': Ile ---*"410*''' -,„ J , ,z,,„ii.2
<br /> --, f`'..,'t'-; '- .,. ".'"pri "'',..,,‘-''. '
<br /> t
<br /> Sign--at.-. ure'.- of A'p`p....;,'lic.g.z3a"n. t: ." : ,
<br /> tate
<br /> ----,..
<br /> cP'... -4 'VI-4.-ty ,. - 4'-'4.'41,.- -': *-• - *:::: ,'''''' '*4-404',.1 4
<br />
|