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` CITY OF ORONO APPLICATION FOR PLOMBING 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 applicationa 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. Permi.ts 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 conatruction 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 reqnired. <br /> ****,t**************************************,k*,t************************tr**** <br /> JOB SITE ADDRESS: _ _�����" ' ��,�¢�� ��� <br /> Occupancy Type: � Residen al Commercial <br /> OWNER'S NAME: ������ /���, Phone No. : ��f�$��"`� <br /> Mailing Address: � ___ City: <br /> CONTRACTOR'S NAME: Bus. No. : ��`'"y���-fi��� <br /> Mailing Address: �� d � " ' " - City: �����, Zip:����- <br /> Master Plumber's State License 1� . : ���`� City�Cert. No. : <br /> *************************************************************************** <br /> PLUMBING FIXTURE SCHEDULg <br /> (Show number of fixtures of each type on each floor) <br /> FIXTURE TYPE BSMT 15T FLOOR 2ND FLOOR OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER <br /> � ------------- ---- ----+----- ------ ------------- ---- ----�---- --------- ----- <br /> . -_-- ---T----- <br /> Water Closet �- Sewer E ector <br /> ------------ --- --- --- --- ---- ------�---- -- --•---- ------- ---- <br /> Lavatory �_ Laundry Tray <br /> ------------- --- -------- -------- ------ ------------- ---- ---•----- --------- ----- <br /> Bathtub ' Washer <br /> ------------- ----- ------- ------- ------ ------------- ---- ---^----- --------- ----- <br /> Shower Water Heater � <br /> ` Kitchen Sink 'I __-_-_ Water Softner <br /> �, -------------1----- --�----- -------- ------------- ---- - ----- --------- ----- <br /> Disposal __-__ Wet Bar __-: <br /> ��' ------------- ----- ------ ------- - p---P--- ---- ---- --------- ----- <br /> Dishwasher Sum Pum <br /> ------------- ----- ----•--- --------- ------ ----�-------- ---- ------- ---------- ----- <br /> ��' Sillcocks Misc (List) <br /> ------------- ----- ---•--- --------- ------t------------- ---- <br /> Floor Drains -----1------------- ---- ---y <br /> � ------------- ----- ---�---- --------- - _ ---- ---------- ----- <br /> *************************************************************************** <br /> 1. Fixture Fee The minimum permit fee is $30.00 $ ��BC! � <br /> Compute number of fixtures x $8/fixture <br /> x $5/fixture reset <br /> 2. State Surcharge $ .50 <br /> 3. Postage & Handlinq (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PBRMIT FEE (add lines 1-3 above) $ �� �(1� <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 /> , � � <br /> � <br /> Signature of Applicant: Date: ��'�� ��� <br />