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CiTY OF ORC�O �PPLIC�TION �OR PLUMBZ�G PERMIT <br /> Box 66 t1335 So Brown Rd) <br /> Crystal Bay, MN 55323 <br /> �*******************��*****x**xr�**************�************�************** <br /> General Instractions <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 da1 the agplication is receined. <br /> 3. Permits are not valid until pon receive a permit cazd. <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 invol ved, a separate building permit must <br /> be obtained. <br /> 7. A1 1 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 honr notice reqnired. <br /> ******************************************* * **************************** <br /> - JOB SITE FiDDRESS: ' � � �t <br /> ..-- Occugancy Type: �_Residential ommercial � <br /> fj � � <br /> OWNER'S NAME: Phone No. : � j➢ �pr � � _ <br /> Mailing Address: City: <br /> � . � ��� <br /> CONTRACTOR'S NAME: ,f � Bus. o. : <br /> Mailing Address: �s�� City: � r Zip:��� <br /> Master Plumber's State ice se No. : . City e No. : <br /> ****************�****************�***************************************** <br /> PI,IIMBING FIXTIIFTE SCHEDIILE <br /> � (Show number of fixtures of each tyFe on each floor) <br /> � FIXTURE TYPE BSMT 15T FLOOR 2ND FLOOFt OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER <br /> V:ater Closet �---- ----+-----r---- ----�------�Sewer-Ejector ---- ------- ---------�----- <br /> �����.��������1������������� <br /> Lavatory � �' ---�------ Laundry-Tray- ---- ---•----- ---------� ----- <br /> ------------- �----i-------+-- I <br /> Bathtub i I Washer ___1___^___ ________ __-- <br /> - -------------1-------------1-- ----�------ --------------�- -r- <br /> _ Shower------ i ---�--•-----I------- ------�water_fieater- ----�---•----- --------- ----- <br /> -;- <br /> - � Ritchen Sink ; j ( Water Softner�_ 1__ <br /> Bisposal-----1-----I ------ ------- ------ Wet_Bar------ ---- ---•--- --------- ----- <br /> � <br /> I ' <br /> Dishwasher � Sump Pump � <br /> Sillcocks----1-----i---- --- -------- ------ Misc. (List)- ---- ------- -------__' s---- <br /> � � Floor Drains --- - --- -------- ------ ��=��'-- �1 ------- --------- ----- <br /> *************************************************************************** <br /> 1. Fixture Fee The minimum Fermit fee is $30.00 $ <br /> Compute number of fixtures x $5/fixture <br /> - x $3/fixture reset <br /> •"::�:`�;_:c: <br /> , _= 2. State Surcharge $ .50 <br /> � 3. Postage & Handlinc� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FSE (add lines 1-3 above) $ <br /> **�**************************************�r********************�**�****�a**** <br /> The undersigned hereby applies to the City of Orono for issuance of a Plumbing Permit, <br /> agree� to do all work in strict accord�nce 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 /> . � � � <br /> Signature of Applicant: Date: <br />