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� CITY OF ORONO APPLICATION FOR PLUMBIAIG PERMIT <br /> Box 66 (1335 So Brown Rd) <br /> Crystal Bay, MN 55323 <br /> _- , . -*************************************************************************** <br /> General Instructions <br /> 1. Ycu may apply fo� pl_umbing permits by �r,aii or in person at the City oftices. <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 /> _. P+�rmi.ts a�e not va3iA 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: Cpa� /��r�h �CX�r1CI�,,��C7C1 <br /> Occupancy Type: }�, Residential � Commercial <br /> OWNER'S NAME:�����,,,,-�% ��,`,,�i.,.,�,t-£ Phone No. : <br /> Mailing Address: City: <br /> CONTRACTOR'S NAME: ^: y�- ° Bus. No. : "I�JJ� ��'�I� `� <br /> Mailing Address: (- l{ �: \ <� City: h-1-y{�. Zip:�� <br /> Master Plumber's State License No. : 1�-� ►'"1l�'_� City Cert. No. : <br /> *************************************************************************** <br /> � � PLUMBING FIXTIIRE SCHEDULE <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 /> e,�c�` -------------�---- ----�----- --- .----- ------ ------------- ---- ----�---- -------- <br /> ��' ^ _ _ <br /> - <br /> � ' P.ater Closet I I � Sewer E ector <br /> . <br /> -------------1----�---- --- f <br /> LaJatorY----- } --- --�----�------- ------ La-n3rY---aZ- ----�---•-----L-------- ' ---- <br /> �; - -L- <br /> Bathtub � j , I Washer i <br /> ------------- -------- — - ------ ------------- ---- -------- --------- ----- <br /> � <br /> . Shower ------;-----' � -- -- - Water Aeater -------- , <br />- � ------- l-----^--•----- ------- ------ -------------�---- ---�----- - ----- <br /> " Ritchen Sink ' ----I � � _ Water Softner � I <br /> --------------- ---•— - -�- -----�-------------1--- � --�---- -------- ----- <br /> . \ --- - - --- - -- <br /> � Bisposal � � I_ Wet Bar � <br />\ `� -------------1-----L----- ------�� ---- ----------- -- --•---- --------- ----- <br /> V- Bishwasher � � I �- Sump Pump ( <br /> ,�� -------------1---- ' --- -- ---- -- ---- ------------ -- ------- --------- ----- <br /> � b\� Sillcocks � � Misc. (List) ' r <br /> � . �C -�=-------- ----- ---�--- --------- ------ ------------- ---- ---.�=-- -=��=-- -- <br /> �,,, --- <br /> ,, � or Drains_�_ �_ �_ �- � - � <br /> --- ---- --�----�--------- ------ ------------ --- -------- �'nr� _ <br />�� - -� �********************�**************************************** �� <br />�/`` . Fixture Fee The minimum �ermit fee is $30.00 $ ��, Q(� <br /> Compute number of fixtures � x $5/fixture <br /> `�_ � x $3/fixture reset , ��? <br /> . �., �+'�. LIC� �jc.,b 0.\rec <br /> \�J 2. State Surcharge � $ .5 0 ���'-�-��� <br /> � / 3 . Postage & Handling (Only mail-in applications) $ ---��"'� <br /> �����'/ <br /> ��-> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ C�(p��� <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 /> � �� <br /> Signature of Applicant:���n-�J ���iy�.,�,"� Date: `� L-� -�� _ <br />�: <br />