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CITY OF ORONO APPLICATION FOR PLUMBING PERMIT <br /> Box 66 (1335 So Brown Rd) <br /> Crystal I3ay, MN 55323 ,_,. <br /> **********,�**********************************************���i�r*******�***�, <br /> General Instructions ,- � <br /> 1. You may apply for plumbing permits by mail or in person at the City offices. ��}''`1 { <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 not valid until yon receive a permit card. <br /> 4. Work minst not begin unless the permit card is available on the job site. <br /> 5. Plumbing permits may be issued to licensed contractors only. AU G 1 5 �� <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 hour notice required. <br /> ********�t*************************************�*,�*************************** <br /> JOB SITE ADDRESS: ��0� �fjf/'�',�Q�C./G, <br /> Occupancy Type: � Residential —�mmercial <br /> OWNER'S NAME: ,� 1J Ph�n� .30. : <br /> Mailing Address: City: <br /> CONTRACTOR'S NAME: �/� S �G G Bu s. No. : �������` <br /> Mailing Address: / U - Q City: �'J`fT/jxl. Zip: ,3 � <br /> Master Plumber's State License 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 1ST FLOOR 2ND FLOOR OTHER <br /> ------------- ---- ----a----- ----r----- ------ ------------ ---- ----�---- --------- ----- <br /> Water Closet �_ �_ Sewer E'ector <br /> ------------- --- --—---- ---- ---- ------ ------�---- -- --�---- ------- ---- <br /> Lavatory Laundry Tray <br /> Bathtub Washer <br /> � <br /> --- ---^---- --------- ----- <br /> Shower ------ Water Heater <br /> -------------�-----�---•----- -------- ------------- ---- ---•----- --------- ----- <br /> Ritchen Sink ' Water Softner <br /> -------------�---- --•----- ------- ---- ------------ -- ------ -------- ---- <br /> Disposal I- ---__ Wet Bar <br /> -------------1 --- ------ ------ --------- -- --•---- -------- ---- <br /> Dishwasher Sump Pump <br /> _____________1_____ ____ __ _______ _____ ___________ __ ______ ________ ____ <br /> sill�o�ks ;:is�. (:,is�; <br /> Floor Drains <br /> ****************************************************************�*�t******* <br /> 1 . Fixture Fee The minimum permit fee is $30.00 $ �Q CJ <br /> Compute number of fixtures x $5/fixture <br /> x $3/fixture reset <br /> 2. State Surcharge $ .50 <br /> 3. Postage & Aandling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT 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 Diinnesota, and certifies that all statements made on this <br /> application are complete, true and corrp.etz <br /> / <br /> \ <br /> � <br /> Signature of Applicant: / ��G / ��. Date: �'��� <br />