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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 Znstructions <br /> 1. You may appl} for plumbing pe�-mits by mail or in person at tne City uffices. <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 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 invol ved, 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 reqnired. <br /> � <br /> ****************************************��********************************* <br /> JOB SITE ADDRESS: I q�� � �>��'y"��,;�� '�-�,��f� �� (��� <br /> Occupancy Type: x�Resid tial Commercial <br /> OWNER'S NAME: -� � Phone No. : t"� �'- ����L� <br /> Mailing Address: � c �;.- City: ,�,���, <br /> CONTRACTOR'S NAME z��G,��,p��� �v��-��r�., C° �,�-,�-, Bu s.��� �� �� I� <br /> / <br /> Mailing Address: �SCc�I i�k��.�,Q,a-.��..�n�.aA� �l City: Zip�� <br /> Master Plumber' s State License No. : J�.(/7 L. 3 City Cert. No. : <br /> *************************************************************************** <br /> • PLUMBING FIXTIIRE SCHEDULE <br /> - (Show number of fixtures of each tyFe on each floor) <br /> . FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER <br /> ------------- --- -+----- - --- -- ---- -- ---- --------- --------- ----- <br /> ��� <br /> -=T----- --- - --- <br /> 6:ater Closet __--- Sewer Ejector � <br /> -------------1--- , <br /> -------- -- - ---- - -+- -L----- <br /> -a----r�----- �--------—----�-------- I------ILaur.drp-m aY-�--- � --�-----I -------- I ---- <br /> �1� ��� <br /> r <br /> Bathtub i � � �Washer ` <br /> _____________i____ � ______ � _ __ ____ ___________ ___1______ _______ ____ <br /> ____^ __J_ _ _ ___ _ _ _ _ _ _ <br /> ._ Shower , I I Water Heater I <br /> ------------ ---�---- +------- ------ --------------{----�---•----- --------- ----- <br /> _� <br /> - : Ritchen Sink ' ' I Water Softneri ( I � <br /> -------------�---- �--•---- � --------�------y-------------1--- --•---- -------- ----- <br /> - --- -�- -= <br /> i � <br /> Bisposal __-_� � Wet Bar i ' <br /> � <br /> -------------1- �----- ------ ---- ------------- ---1---.-----�--------- ----- <br /> Bishwasher � �' Sum Pum � ----_____I <br /> -------------1---- --- -- --�--- ----- ---p----P---- -- ------- - ----- <br /> SillCOCks � _� MisC. (List) <br /> ------------ I --- � --•-- -------- ----- ------------ --- ------ ---------�----- <br /> Floor Drains I I__ ��U,r,��, I _ <br /> _____________ _____ _�____ _________ ______ _____________ ___I_ ________ __________� ---- <br /> ****************************************** ***************************** <br /> 1. Fixture Fee The minimum permit fee is $30. 0� $ �C�(�� <br /> Compute number of fixtures x $5/fixture <br /> x $3/fixture reset <br /> 2. State Surcharge $ .50 <br /> 3 . Postage & Handling (Only mail-in applications) $ --s��.�. ° <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 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 /> Signature of Applicant t I�//i'�� �C���_ _ Date: y-`�� �-�� <br />