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• 'CITY OF ORONO APPLICATION FOR PLIIMBING PERMIT <br /> Box 66 (1335 So Brown Rd) <br /> Crystal Bay, MN 55323 .. ��( �� <br /> *************************************************************************�* <br /> iGeneral 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 yon receive a permit card. <br /> 4. Work must not begin unless the permit card is available on the si e ';-���; <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 8one in accordance with State Code requirements. <br /> 8. A1 1 work must be inspected before it is covered. Call 473-7357. <br /> 24 honr notice reqnired. <br /> *******************r*************�**********I******* *********************** <br /> JOB SITE ADDRESS: ly'�`; �G�-1 �,�,�-G�z _��l . ��<<,�lr�x',r�i� 1^t"��'1.�,,� �-�;�;�ti � , <br /> Occupancy Type: �c Residen ial � Commercial � <br /> OWNER'S NAME: Phone No. : <br /> Mailing Address: City: <br /> /� C'�_._ � , , <br /> CONTRACTOR'S NAME: '�(�1� ����(�`rZ�I��y��`�� c�l �;r'a�� Bus. No. : - �'j'�� � � I � _,�- <br /> c � <br /> Mailing Address: 1�--1��C>1 � c`\r, ��=1�0.� �-rity: (�-�!�, Zip:�_;_,i�`� <br /> Master Plumber's State License No. : '(Y��'�1��� City Cert. No. : <br /> *************************************************************************** <br /> PLIIMBING FIXTURE SCHEDIILE <br /> (Show number of fixtures of each type on each floor) <br /> FZXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER <br /> ,------------- ---- _-�---- ---T----- ---- ------------- ---- ----�---- --------- ----- <br /> V7ater Closet Sewer Ejector <br /> _____________I____)__ _�____ ____ ____ ______ _____________ ____ ___._____ _________T_____ <br /> La�atory � � I � Laundry �ray � <br /> t�,� -------------�----�---—---- -------- ------ ------------- ---- ---•----- ---------�----- <br /> X � <br /> 1j� Bathtub � � � Washer <br /> / �� -------------�----=-- ---- -- --- ------ ------------- ---- ---^---- --------- ----- <br /> -� Shower � � Water fieater <br /> --------------�---- --•----- ------- ------ ------------- ---- --�----- --------- ----- <br /> I � <br /> Ritchen Sink j Water SoftnerI <br /> ------------ --- � ----- -------- ----- --------------+---- -------- -------- ----- <br /> _ --•- - - - - - <br /> Disposal Wet Bar <br /> -------------1---- ---- ----- ----- ------------- -- ---.---- --------- ----- <br /> Dishwasher �- S�A P�P <br /> ------------- ` ---- ----•--- ---------- ------ ------------- ---- ------- ---------- ----- <br /> Sillcocks I Misc. (List) <br /> ------------- —•--- --------- - - — - <br /> --- ---- <br /> ---------- <br /> Floor Drains <br /> _�_____�______I_____________ ____ ________ ____ <br /> _____________I=====I==_____ _ ______ ______ _____ <br /> *************************************************************************** <br /> 1. Fixture Fee The minimum permit fee is $30.00 $ ���, C� �+ <br /> Compute number of fixtures � x $8/fixture <br /> x $5/fixture reset <br /> 2. State Surcharge $ .501 <br /> :\ <br /> 3. Postage � Handling (Only mail-in applications) $ �.50 � <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ � - _ "�,t;--�� �rr��. <br /> *************************************************************************** <br /> The undersigned hereby applies to the City of Orono for issuance of a Flumbing Permit, <br /> agrees to do all work in strict accordance with the ordinances of the City and the <br /> •regulations of the State o£ Minnesota, and certifies that all statements made on this <br /> application are complete, true and correct. <br /> �%J <br /> Signature of A�plicant: / �1� (r.(/�/J���'� Date: '���� - ��, <br /> � <br />