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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 Instrnctions <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 be�low. <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. A1 1 work must be done in accordance with State Code requirements. q ��� <br /> 8. All work must be inspected before it is covered. Call 473-7357. 24 h���a�ot`i� <br /> required. L <br /> *****************^ *�t*****************************************�r************ <br /> JOB SITE ADDRESS�_�� �(.��„ ��1� ���i� <br /> Occupancy Type: �_Residential Commercial <br /> OWNER'S NAI�: ����e� ,L�n �. � n� Phone No. : ���- Oy� '. <br /> Mailing Address: ��-l�gp ►1/. Z,k.,;,y�, S�t, �,f /(�� City: p=��Oc��, f/'�.�;�J' T�.�y�f <br /> CONTRACTOR'S NAAII�: L-�A K�,5�cX F �\1.,�,�.n�l;v��; Bu s. No. : ��y-�lbC�C <br /> Mailing Address: 1�y�,�� �;,���„� P�y.. City: �RVAc�� t SS3'7� <br /> Master Plumber' s State License No. : �3 5��� (Y� City Cert. No. : <br /> *************************************************************************** <br /> PLQMBING FIXTURE SCHEDOLE <br /> ' /� (Show number of fixtures of each type on each floor) <br /> 1 � FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER <br /> ------------- ----- --------- -------- ----- - ----------- -------- ----- -------- ---- <br /> Water Closet ''7 � Laundry Tray ` <br /> � ------------- ----- --------- -------- ----- -------------- -------- ----- -------- ---- <br /> � Lavatory � � Washer � <br /> ------------- ----- --------- -------- ----- -------------- -------- ----- -------- ----- <br /> Bathtub ` Water Heater `, � <br /> ------------ --- --\--- -------- ----- ------------- -------- ----- -------- ----- <br />" Shower � � Water Softner <br /> ------------- ----- --------- -------- ----- -------------- -------- ----- -------- ----- <br /> Kitchen_Sink --- --1---- ------- ----- Misc�_(list�- ------- ----- -------- ----- <br /> Disposal i <br /> ------------- ----- --------- -------- ----- -------------- -------- ----- -------- ----- <br /> Dishwasher <br /> ------------ --- --�--- ------ ---- ------------- -------- ----- -------- ----- <br /> wet Bar � '� <br /> ------------- ----- --------- -------- ---- -------------- -------- ----- -------- ----- <br /> silloocks Z <br /> ------------- ----- --------- -------- ---- -------------- -------- ----- -------- ----- <br /> Floor Drains _ \-_ ` <br /> ------------ 1 ------- ------- ---- -------------- ------- ----- -------- ----- <br /> Sump Pump <br /> Sewer Ejector <br /> ******************************** ****************************************** <br /> 1. Fixture Fee The minimum permit fee is $30.00 $ ��---�=-���_�/d• S d <br /> Compute number of fixtures � x $4/fixture <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) $ ,� ��� �� g <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 Min ota, and certifies that all statements made on this <br /> application are complete, true a correct. ` <br /> _- ---__ __ .___� <br /> J Signature of Applicant: Date: 9- /`� � J� <br />