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. ',.�x b b t 1.3.i`� 5u �il U��11 kci/ . �, -�� <br /> � • Crystal Bay, MN 55323 <br /> �, ************************************************************�************** <br /> General Instructions <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 ma3.1 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 3.ssued 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. All work must be inspected before it is covered. Call 473-7357. <br /> 24 honr notice required. <br /> **********************,t***********************,t****��********************** <br /> JOB SITE ADDRESS: �9�? ���j� �('t.(�'j7�hYqQ WC� h' <br /> Occupancy Type: � Reside tial Commercial <br /> OWNER'S NAME: (�� (�.�p��irr✓ Phone No. : ��/-���� <br /> Mailing Address: ���,�� City: <br /> CONTRACTOR'S NAME: BL16. TTn. ; ��'""�j/�-�'�; -� <br />� Mailing Address: � � � City: ���_ Zip: �:�`;t���' <br /> Master Plumber's tate License No: City�Cert. No. : <br /> ************************************** ************************************ <br /> PLUMBING FIXTORE SCAEDULE <br /> (Show number of fixtures of each ty�e on each floor) <br /> FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER <br /> ------------- --- �----- ----r----- ------ ------------- ---- ----•---- --------- ----- <br /> Water Closet Sewer E ector _ <br /> ------------- ---- -------- ---- ---- ------ -------]----- ---- --- -'t--- --------- - ,-- <br /> Lavatory Laundry Tray <br /> Bathtub Washer <br /> ------------- -----�-------- ------ ---- ----------- -�-1 --^--- ------- ---- <br /> Shower Water Heater 7� <br /> --------------�----- --•----- -------- ------ ------------- -�\ ---•----- -----_--- ----- <br /> Kitchen Sink ' Water Softner OCT 6+ `'�. � <br /> -------------�---- --�----- -------- ------ ------------ --- --�---- -----�� ---- <br /> Disposal I_ Wet Bar <br /> -------------1 --- ----- ----- ---- ----------- -- --•---- -------- ---- <br /> Dishwasher __ I- Sum Pum <br /> ----------- 1 --- --- -- ---- -- ---- --p----P--- -- ------ -------- ---- <br /> Sillcocks �_ ______ Misc. (List) <br /> ------------- ---- ---•--- --------- ---------- ---- ------- ---------- ----- <br /> Floor Drains_i_ 1_ .�_ .1_ 1_ 1____1____ �_ �_ <br /> ------------ 1 ---- --�---- -------- ----- ------------ ---- --------- ---- - <br /> *******************************,t******************************************* -- <br /> 1. Fixture Fee The minimum �ermit 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 PERMIT FEE (add lines 1-3 above} $ 3 � � C��� <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 l�pplicant: /��� , Date: /Q-%—q� <br />