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ti..i�� vs v�r�.e�.v ,CiYY�ll.iil3VfV L•liY� i'LU['ri2511Y(i 1�1:1tC�11'1 <br /> Box 66 (1335 Brown Road South) <br /> Crystal Bay, MN 55323 <br /> , ' ************************************************************************** <br /> Genezal Information <br /> i <br /> 1. You may apply for plumbing permits by mail or in person at the City offices. <br /> 2. Mailed in application are subject to the postage and handling fees shown below. Permit Cards will <br /> 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. wozk must not begin until the permit card ia posted on the job site. I <br /> 5. Plumbing permitsmay be issued to state-licensed plumbers or to homeowner/occupants who intend to ' <br /> actually perform their own wozk in their home. <br /> 6. When any new construction or remodeling is involved, a separate building permit must be obtained. <br /> 7. All work must be done in accordance with the State Building Code Requirements. <br /> 8. All work must be inspected before it is covered. Call for inspections 24 hours in advance <br /> (473-7357). •� , <br /> Instructions. Complete all items on this application. Compute the permit fee. Sign and date thel � �jV <br /> certification. Incomplete applications will not be processed. If you have any questions, call J <br /> 473-7357. <br /> WALK-IN PERMITS--Apply at City Offices, 1335 Brown Road So. (County Rd 146) I <br /> MAIL-IN PERMITS--Enclose Fee--Mail to: P.O. Box 66, Crystal Bay, MN 55323 <br /> ******�It***********************�IF'*�k***********it******�k**�F***�k9F*ic***�IF*�k**�kot** � <br /> JOB SITE ADDRESS_ .,�SC`"C" c�,._S c r� �f/��� <br /> Occupancy Type: _ C� Residential Commercial <br /> 4�Iork to be Performed by: _� Licensed Contractor Owner/Occupant <br /> OWNER'S NAME ��,j�( ����� Te lephone No. �7/ —�� �� �� <br /> Mailing Address e-��:�. C:� s� r. ✓^�, � o/ �n �.. � . .��3 �i <br /> PLUMBER'S COMPANY NAME ��,;,�,� ,��,�,�5�., �,, �l,A:.t�.<,.,�o , $u s i ne s s No. y'7 sf- yy�'`f <br /> Mailing Address /Yiiljr, .�at�'ei,°;� w� .�-i�-� � �rc�/.S ,'�,{ 1,-► S�i� 3i _ <br /> Master Plumber' s State License No.�'c"�7Z� �`► City Cert. No. <br /> ************************************************************************** <br /> PLQMBING FIXTURE SCHEDIILE <br /> (Show Number of Fixtures of Each Type on Each Floor) <br /> FIXTURE TYPE BSMT. Lst Floor 2nd Floor � Other Floors FIXTURE TYPE BSDiT. lst Floor 2nd Floor � Other Floors <br /> Water Closet Laundrv Tray _ <br /> Lavatorv � Washer � _ <br /> Aathtub � Water ifeate: � <br /> Shower � _ � Water Softner � � <br /> Kitchen Sink 1 _ Misc. Fixtures: t <br /> Dis�osal (List) I <br /> Dis;washer � <br /> — - f � ; r. -- — ---- - <br /> we� Bar <br /> Sillcocks � <br /> Floor Drains <br /> Sum Pumo <br /> Sewer E�ector TO'!'AL `7UMBcR OF FIXT�'RES <br /> 1k**7k***1F**�k**7k*7k************�k7k****�t*7k*7k****�t�k7k**7k7k***7k7k�k*'k*7kit**�k*7k**7k7kic*7Y7k <br /> PERMIT FEE CALCULATION <br /> 1. Fixture Fee. The minimum permit fee is $25. 00. <br /> Compute number of fixtures x $4/fixture $ <br /> 2 . State Surcharge $ , �p <br /> 3 . Postage and Handling (Only for Mail-in applications ) $ 1. 50 <br /> 4. TOTAL Permit Fee (Add lines 1-3 above ) $ <br /> ************************************************************************** <br /> 2he undersigned hereby applies to the City of Orono for issuance of a PLUMBZNG PERMIT, agrees to do all <br /> work in �ict accordance with the ordinances of the City and the regulations of the Minnesota state � <br /> Build' g C e, er ' 'es tha . 11 statements made on is app ication aze complete, true and <br /> corr ct. <br /> S' na ure of Ap icant Dat� ,� <br /> I <br />