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0 <br /> CITY OF ORONO APPLICATION FOR PLUMBING P <br /> , � Box 66 (1335 So Brown Rd) <br /> Crystal Bay, MN 55323 <br /> ************************************************************,�.�******����� <br /> ,t�General Instructions � <br /> 1. You may apply for plumbing permits by mail or in person at the City offic�gs. <br /> 2. Mailed in applications are subject to the postage and handling fees�Fs own bel D <br /> Permit cards will be sent by return mail the same day the application is �ceived. � <br /> 3. Permits are not valid until you receive a permit card. f <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: ;�y,sV �o:�n 7��-5, Sic�,� <br /> Occupancy Type: �_Residential Commercial <br />� OWNER'S NAME: S`��/�l�-;,,; s ��-r"f, �.(r Phone No. : L/7SJ- oy y_j <br /> Mailing Address: City: <br /> CONTRACTOR'S NANiE: ��r r-��-1 s �l�,,,, 6�, ,� � Bu s. No. : <br /> Mailing Address: �s"ii ��y 7 �£xc� s.o.- City: .�r",�< </S ,..,;- Zip: S s"yj� <br /> Master Plumber's State Lic nse No. : City Cert. No. : <br /> *************************************************************************** <br /> PLUMBING FIXTURE SCHEDULE <br /> (Show number of fixtures of each type on each floor) <br /> FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER FIXTURE TYPE BSMT 15T FLOOR 2ND FLOOR OTHER <br /> ------------- -- ----+----- --=T----- ---- ------------- ---- ----�---- --------- ----- <br /> Water Closet_�_ Sewer Ejector <br /> ------- --- ---—---- -- - ---- ------ ------------- ---- ---•----- --------- ----- <br /> Lavatory Laundr Tra <br /> ------------- -----�---—---- -------- ------ ------y----Y- ---- ---�----- --------- ----- <br /> Bathtub ( Washer <br /> ------------- -----� ------- ------- ------ ------------- --- ------- ------- ---- <br /> Shower ^ Water Fleater <br /> --------------�-----�--•----- --------- ------ ------------- � ---�----- --------- ----- <br /> Ritchen Sink f Water Softner <br /> ���_���������1���_� ��'_����. ����'���� ������ �����������`� ��__ ���.����� �.�������� ����_ <br /> Disposal Wet Bar <br /> -------------1----- --_--- ------ ------ ------------- -- --.---- -------- ---- <br /> Dishwasher Sump Pump <br /> Sillcocks Misc. (List) <br /> Floor Drains- ---- --- ---------- ----- ---------- ----- <br /> - ' - —- <br /> ------------- --- -- <br /> ***********,t********it***********it****************************************** <br /> 1 . Fixture Fee The minimum permit fee is $30.00 $ ;� �L:' , (,�` <br /> Compute number of fixtures x $5/fixture <br /> � x $3/fixture reset <br /> 2. State Surcharge $ .50 <br /> 3. Postage � Handlinq (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ � ��g .� '�,y�� �� z-� <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 rtinnesota, and certifies that all statements made on this <br /> application are complete, true and correct. <br /> Signature of A�;plicant:��C��� Date: � �`</ <br />