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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 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 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 reqnired. <br /> *************************************************************************** <br /> JOB SITE ADDRESS: � `� :�J %���� „�,-� .� /c_,,%z <br /> Occupancy Type: Residential ,/ Commercial <br /> OWNER'S NAME: /7�Y � %'��v a �<<c�A7 .5' �' Phone No. : <br /> Mailing Address': ;� iy -� �--.�� �.�. :.; �o,..<. City: �� ,.-�;. � <br /> CONTRACTOR'S NAME: �<<'-/� �/ �� - ;� � Bu s. No. : ��9-�L �'e- <br /> Mailing Address: ,�� ; - �r City: �f./,;,._ ��;..-Zip: �s"'i a f <br /> Master Plumber's State Lice se No. : 3 5"7.S ;'I City Cert. No. : <br /> *,t*******************************************************,t***,t****,t**,t***** <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 /> ------------ -+----- ----r----- ------ ------------- ---- ----�---- --------- ----- <br /> Water Closet , ,�- Sewer E�ector <br /> ------------ --- /�es�-- --- --- ---- ----------- -- --•---- ------- ---- <br /> Lavatory �1 t _-__-- Laundry Tray <br /> ------------ --- �-`'-1-`-- ------ ---------- -- --�---- ------- ---- <br /> Bathtub washer <br /> ------------ ----�------- ----- ---- ----------- -- -------- ------- ---- <br /> Shower -_-__ Water tleater ` <br /> ------------- -----�--•----- --—---- - ------------- ---- --•----- --------- ----- <br /> Kitchen Sink 'I � -_-_-- Water Softner <br /> -------------j---- I -�---- ------ ----------- -- --�---- -------- ---- <br /> Disposal I_ v -__-__ Wet Bar <br /> -------------1 --- ---- ----- ----------- -- --•---- -------- ---- <br /> Dishwasher I- � ---_-- Sump Pump <br /> -------------1 --- -- — -- --------- ------------ --- ------ -------- ---- <br /> Sillcocks Misc (List) <br /> ------------- ----- ---•--- --------- ------ ------------- ---- ------- ---------- ----- � <br /> Floor Drains <br /> - �- - -- - - ----- ----- <br /> *****,t**************************************,t****************,k************* _ <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 Handling (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 D7innesota, and certifies that all statements made on this <br /> application are complete, true and correct. <br /> Signature of A�:pli.cant:y��l�f�" �%�"C, � �-- Date: �- � � -' ��L <br />