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� <br /> CITY OF ORONO � APPLICATION FOR PLUMBING 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 poatage 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 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. All work must be done in accordance with State Code requirements. <br /> 8. Al1 work must be inspected before it is covered. Call 473-7357. <br /> 24 honr notice reqnired. <br /> *************************************************************************** <br /> JOB SITE ADDRESS: � � � 5 �� �c ri LC.% �% ��' ��'`� �i <br /> Occupancy Type: �� Residential ommercial <br /> OWNER'S NAME:�G �� �� �� ' �-/�-!' r v{�� � ✓� Phone No. : <br /> Mailing Address: City: <br /> CONTRACTOR'S NAME: �i t � r�l -� � �"� N , .�v� L� Bus. No. : <br />� Mailing Address: �;> > v �� �-L ,l�: City: �!� ��'.�� ='i�.,� Zip: �� �i �� <br /> Master Plumber's State License No. : ;� �� �, �7 City C rt. No. : <br /> *************************************************************************** <br /> PLUMBING FIXTURE SC$EDUL13 <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 /> Water Closet 1 � ----__ Sewer Ejector <br /> ------------ --- ---�-- --- ---- ------------- ---- ---•----- --------- ----- <br /> Lavatory �� � Laundry Tray <br /> ------- <br /> Bathtub `� Washer <br /> ------ <br /> Shower ) Water Heater <br /> ------------ --- --�---- --�--- ------ ------------- ---- ---•----- --------- ----- <br /> Ritchen Sink ' Water Softner <br /> -------------�---- -•----- ------- ------ ------------- ---- ---�----- --------- ----- <br /> Disposal Wet Bar <br /> -------------�---- ------ ------- ----- ------------- ---- ---�---- --------- ----- <br /> Dishwasher___ I- Sump Pump ` <br /> --------- 1 --- --- -- --------- ----- ------------- --- ------- ---------- ----- <br /> Sillcocks Misc. (List) <br /> Floor Drains <br /> ------------- ----- ---�---- --------- ---- <br /> *************************************************************************** <br /> l. 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 b Handlinq (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ ��' S/� � <br /> *************************************************************************** <br /> The undersigned hereby applies to the City of Orono for issuance of a Plumbing Permit, <br /> agrees to do all work in atrict 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 /> �1 --� _ / <br /> Signature of Applicant: � � (�;��� ;�? �-��-��---- Date: ��` �(�` �,�- <br /> / <br /> � <br />