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CITY OF ORONO APPLICATION FOR PLDMBING 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 below. <br /> Permit cards will be sent by return mail the same day the application is received. <br /> 3. Permits are aot valid nntil yon 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 invol ved, a separate building permit must <br /> be obtained. <br /> 7. A1 1 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 /> *************************************************************************** <br /> JOB SITE ADDRESS: � � �� `�— /,�-� ii , t�� <br /> Occupancy Type: �� Residential Commercial <br /> OWNER'S NAME: Phone No. : <br /> Mailing Address: City: <br /> CONTRACTOR'S NAME: � "j'-e , t�J� y-,-_.C.:.c k�� K�. 1 1� � Bu s. No. : �-E-J �%- /:� �� X <br /> Mailing Address: ; �'`' ; L /c< [ �, : �, � � City: E� � c.� f s;��. Zip: �'��s � <br /> Master Plumber's State License No. : �ts'� City Cert. No. : <br /> *************************************************************************** <br /> PLIIMBING FIXTIIRE SCHEDOLS <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 /> ------------- -+----- --=T----- ------ ------------- ---- --------- -------- <br /> � �� <br /> �L P:ater Closet � ' Sewer Ejector <br /> -------------1----�------- - - ---- ----- ------------- --- ---�---- --------- ----- <br /> , , - - - - - <br /> � Lavatory I � i Laundry Tray ! <br /> ------------- -----�---—---- -------- ------ ------------- ---- ---•----- ---------+------ <br /> Bathtub ( Washer <br /> ------------ --- � ------- -- --- ------ ----------- --- ---^---- --------- ----- <br /> Y� Shower , � � Water Heater <br /> -------------�--------•----- ------- ------ ------------- ---- ---�----- ---------�----- <br /> I I <br /> Ritchen Sink f 1 Water Softner <br /> ------------ --- � ------ -------- ----- ------------- ---- -------- --------- ----- <br /> ---- - - <br /> Disposal Wet Bar ( <br /> -------------1---- ----- ----- ---- ------------- ---- ---.---- --------- ----- <br /> Dishwasher__-�- Sump Pump <br /> Sillcocks Misc. (List) <br /> Floor Drains <br /> *************************************************************************** <br /> 1. Fixture Fee The minimum permit fee is $30.00 $ <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 PgRMIT 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 /> application are complete, true and correct. <br /> � <br /> Signature of Applicant� ��� ,C%v �Z���-' Date: <br />