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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 /> ************************************************ ************************** <br /> JOB SITE ADDRESS: 2-60', f/'I,� L4, �/e7- £L <br /> Occupancy Type: ) Residential / X Commercial <br /> J <br /> OWNER'S NAME: f)�✓ L <br /> A/ `eac.3 Piie'S , Phone No. : 7/- 9' 39 0 <br /> Mailing Address: _ , , B /'E ZcC City: L AZcL2 S/d,e- <br /> CONTRACTOR'S NAME:J i5 k N 2_ l€-0 4� 6J Bus. No. : <br /> Mailing Address: 24p6 uff, L/kx,,v_7 / City:,-tLs,0,2 Zip: -174-2:4 <br /> Master Plumber's State License No. : City Cert. No. : <br /> *************************************************************************** <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 /> -1- T • T r <br /> Water Closet - Sewer Ejector _--- -_ <br /> Lavatory 4. 15b. Laundry Tray Ay <br /> Bathtub Washer <br /> Shower 1 , 1 f Water Heater , —_ <br /> Kitchen Sink ; L J Water Softner I <br /> Disposal I [ I— Wet Bar —_ <br /> Dishwasher 1 L _/) - Sump Pump _--- <br /> Sillcocks L Misc. (List) <br /> Floor Drains 4,' <br /> r <br /> *************************************************************************** <br /> 1. Fixture Fee The minimum permit fee is $30.00 $ 3 Sr ' <br /> Compute number of fixtures x $8/fixture <br /> S- x $5/fixture reset <br /> 2. State Surcharge $ .50 <br /> 3. Postage & Handling (Only mail-in applications) $ -1:5-0- <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ 3 drP-S d. <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 /> Signature of Applicant: dam,.X C31-1`y" Date: / -- , - 9 Z- <br />