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' CITY OF OROIIO APPLICATION FOR PLIIMBING PERMIT G�.� ',::;;';.
<br /> �� Box 66 (1335 So Brown Rd) � ���� .� � � ' �'�'"
<br /> ` � Crystal Bay, MN 55323 :
<br /> *******�x*********************,r**********************�*********** *********
<br /> General Instrnct3ons -
<br /> 1. You may apply for pinmbing permits by mail or in person at 3`.�1P_ City offices.
<br /> 2. Mailed in applications are subject to the postaqe and handlinq fees ahos�n below.
<br /> • Permit cards will be sent by return mail the same day the a;�+lication ia received.
<br /> 3. Permits are�aot valid until yon receive a pernit card.
<br /> 4. Work mnat not beqin unless the permit card is available on t'�� job aite. „
<br /> 5. Plumbing permits may be issued to licensed contractors only. ,
<br /> 6. When any new constrnction or remodeling ia involved, a seF4sat� buildinq permit mu �,�;
<br /> � � ��,,�,
<br /> be obtained. ' � �Q� '
<br /> 7. All wozk must be done in accordance with State Code require�^^.nts. F,;;�.;
<br /> 8. AlI work must be inspected before it is covered. Call 473-^�57. ' `.'"
<br /> 24 hour notice reqnired.
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<br /> Jos sz�s AnnxEss: �//5.-r� ��XC-�sT L�t�K� (L.I��
<br /> Occupancy Type: �_Residential __Commerci��l
<br /> OWNER'S AAMS: � �c��_.l�(,-� _ Phone No. : �7L' Z Z.]S
<br /> Mailing Address: 5�/�� ������5� K r7� City: UI�e�C)
<br /> CONTRACTOR'S NAI�4:: C +�I � c"1 Bu 5, No. : � 7"�j�� -
<br /> Mailing Address: . 2 p� G,ra-R-�i��-� AdG S� City: V►'��c�5 �ip: � ..
<br /> Master Plumber's State License No. : �,�r��=,C�i�� City Cert. No. : i°✓1- D`7f��? _
<br /> ***irlt**!t!t**,t***!t*it*,t�k1FyF1t#,t�k*,tiF***1k1t1t�t�tf��tic*,t,t,t*�k�t�r+t�k,t�t r*tk*yt***1t*�tiri�i��t�t*,t*,ttr�t
<br /> PLIIMBING FIXTURS SCHEDIIL$ ' -'
<br /> ,;.�
<br /> (Show number of fixtures of each type on e�ch floor) �;,;,,,y
<br /> gZXTIIRE TYPE BSMT 1ST FLOOR 2ND FI,OOR OTHER FIXTURE TYPE BSM"' 1ST FLOOR 2ND �:OOR OTHER
<br /> �w�M����� �� ���..i����� '��T����� ������ ������������� �� �����M�� ���������T��M� '
<br /> water Closet Sewer Ejector ; ,':':'�
<br /> ------ ----'---•----- --------- ----- .. .
<br /> --- -------- ----•---- ------ ------- ..
<br /> ------------- - �
<br /> Lavatory Lnundry Tray , -�-
<br /> ------------- --- ------- -- --- ------ ------------- ----?---•----- --------- -----
<br /> Bathtub � Washer � '
<br /> ------------- ---- ------- -- --- ------ ------------- ----�--------- --------- --- .
<br /> Shower Water Heater ,
<br /> ------------ --- -•----- ------- ------ ------------- �'---�---- ------- �.� . .
<br /> - - - ..�...
<br /> Water Softner - • . � -`
<br /> Ritchen Sfnk --------- N�_ '
<br /> Disposal---- ----�------ —------- ----- Wet_Bar------ ----� ---^--- ------- ---- ' -
<br /> >:�.
<br /> � ��•.: _
<br /> - - , ,..
<br /> .:.,.
<br /> Dishwasher Sump Pump � ` '-
<br /> ------------- ----- --�----- ---------
<br /> Sillcocks Misc. (List) ; •
<br /> Floor Drafna � _ '
<br /> --•�--- - ��i�--2' �
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<br /> ' 1. Fiatnre Fee The minimum permit fee is $30.00 $ .
<br /> Compute number cf fixtures - x $5/fixture _ _ _ -_
<br /> X $3/fixture rese} ,_ ,._ �;. .::�__ . -
<br /> . : .__ . . ,_ _ - : - _ .
<br /> .50
<br /> �2. State Surcharge .. -- . -:- $ -- .
<br /> �.: . - -- - -- . :: _. _ __. _ -
<br /> -- -�._ _
<br /> - -- _ ._. _ .—
<br /> -��-" 3. � Postage � Handling (Only mail in applications) S � ' � `` x
<br /> _ . _. .: _ - --- - -- -- - 1 5 -_ �
<br /> - ;_ _ -- _: , ,-,, -- __ _ _ �" �.
<br /> ---- . _�___.- -._:__..... _ � _
<br /> 4 -TOTAL PERMIT FEE (add lines 1-3 above? :_--�- S _ '� � ` ` ``
<br /> . . . =..�`�*#1ri�***�t**1kltlklF****1k**�!***ir**it**1F1t1klF***�t1t***�tlt**1!lttR*s+ #tkvt�t�t�k�k�t�t�tlklkitaF+kie�*�t*1r1r_�--��-- .
<br /> ., .. � .._. ... ..'_- _. ....�: ,�-,--'-'. ._• . � � .
<br /> .-.._--
<br /> . . . ._ . . .. __. _ ._ .� -�-
<br /> . . .._:,..=_� -..•- "'�� -.� -�� -...._. _r,. �-�'-
<br /> ' � -The undersiqned hereby applies to the City of Orono for iase� nce of a Plumbing_^ermit,-`� '
<br /> agreea to do all work in strict accozdnnce with the ordinrnces of the City�rsnd the Y.. .
<br /> segulationa of the State of Minnesota, and certifies that al� atatements made oa thia
<br /> _-. _ _ _.., _,. -'
<br /> application are complete, true and correct. - --- - -
<br /> - . _ .. ..... - - - }
<br /> � ------- _._ _ - - - �
<br /> _.�_ _ _._.
<br /> Signature of Applicant: - _ — Date: �- � ��' - -
<br /> . .�.�. ' . _—.��.. . �. . . . � . .. .' � . ... '' . . ._ . . . ._. • ' K��'..:�.�.� �•n.
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