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LITY OF ORONO t � 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 honr notice required. <br /> *************************************************************************** <br /> JOB SITE ADDRESS: <��/� `� C��`'� ��J'✓ _� � <br /> Occupancy Type: Residential Commercial <br /> OWNER'S NAME: �' �-� �,� � ��� Phone No. : <br /> Mailing Address: �y�y �V s' T City: <br /> CONTRACTOR'S NAME: 1-��l_ l✓ ��-�� �5��'�S Bus. No. : ���� �Y�f��� <br /> Mailing Address: �S'�3� ��?/-r� /�ti�L� City: Zip: <br /> Master Plumber's State License No. : � /,?� City Cert. No. : <br /> *************************************************************************** <br /> PLUMBING FIXTURE SCHEDUL$ <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----- ---T----- ------ ------------- ---- --------- --------- ----- <br /> Water Closet Sewer Ejector <br /> ------------- ---- -- ---- ---- ---- ------ ------------- ---- ---•----- --------- ----- <br /> Lavatory Laundry Tray <br /> ---- ---- ---•----- --------- ----- <br /> Bathtub Washer <br /> ------ ---- ------------- ---- ---^--- --------- ----- <br /> Shower Water Heater <br /> --------------�----- --�----- ------- ------ ------------- ---- ---•----- --------- ----- <br /> Kitchen Sink ' Water Softner <br /> -------------�----- --�----- -------- ------ ------------- --- ------- -------- ---- <br /> Disposal Wet Bar <br /> -------------1----- --_--- ------- ------ ------------- --- --.---- -------- ---- <br /> Dishwasher Sump Pump <br /> ----- ---- ------- ---------- <br /> Sillcocks Misc. (List) <br /> ---------- ----- ---•--- ----•---- ------ --��----`�C- ---- ---- -- ---------- ----- <br /> Floor Drains r.i l;t�K <br /> ------------- ----- ---�---- ---�----- ------ f�.r�;5`;�r' �s't�'�--- ---------- ----- <br /> *************************************************************************** <br /> 1. Fixture Fee The minimum permit fee is $30.00 $ � � . 0 0 <br /> Compute number of fixtures x $8/fixture <br /> x $5/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 /> , -_ <br /> appl cation are complete, true and corr�:' ; - <br /> i" ., � <br /> / 7 <br /> Signature of A�plican�_• /�' "—"L Date: (' '—�-5h� l � <br />