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�� <br /> aCITY_OF ORONO APPLICATION FOR PLUMBING PERMIT <br /> ' Box 66 (1335 So Brown Rd) <br /> '' Crystal Bay, MN 55323 <br /> *************************************************************************** <br /> General Instrnctions <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 /> j 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 issuecl 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: /,3 �L .!��-j�[���C /�}/C�' /E't� <br /> Occupancy Type: X Residential Commercial <br /> OWNER'S NAME: �/V� `' h/C�E Phone No. : ���' �� S / <br /> Mailing Address: �,3 �� ,�y,�,p�,F i9�� City: �,���vJ <br /> CONTRACTOR'S NAME: /��+,$��.( /,,(,G► ��i//'7,[;i n!(; Bus. No. : y� y -s�.�-� � <br /> ,, <br /> Mailing Address: C, (� �' �'�,'r,d/��< Ci �c City: ✓`7A .�,C' s,��,�eip:� � <br /> Master Plumber' s State License No. : �,� y�3 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 /> ------------ -a----- ---�----- ------ ------------- ---- ----�---- --------- ----- <br /> Water Closet � Sewer E ector � <br /> -------------�--- -------- ---- ---- ------ -------�----- ---- ---•----- -------- ----- <br /> Lavatory � Laundry Tray <br /> Bathtub Washer <br />�.. ------------- -----�-------- ------- ------ ------------- ---- --------- --------- ----- <br /> " Shower )( Water Heater <br /> Ritchen Sink 'I ____-_ Water Softner <br /> -------------+----- --•----- -------- ------------- --- ---•----- --------- ----- <br /> Disposal Wet Bar ' � <br /> -------------�I---- ----- ------ ----- ------------ --- --�---- --------- ----- � <br /> - - - - - - - ::. •; <br /> Dishwasher f- Sum Pum ; ,; <br /> -------------1 --- - — -- ----�---- ----- ---P----p---- --- ------- ---------- ---- � <br /> Sillcocks Misc. (List) <br /> i..;. <br /> ; .. <br /> Floor Drains X � '' <br /> r i,. <br /> ------------- ----- ---�`---- ---�----- ------ ------------- ---- ----'---- - <br /> *�k*****�k*�k�t**�k�lc*�It�4�t�t*****iF�t*�k***�k*ic********itic*******�ktk**ir*�k***�k************ '� �: <br /> I '� <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 /> Signature of A�plicant: Date: �' � �" ��' i :, <br /> � � <br />