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CITY OF ORONO APPLICATION �tlR PLIIMBI�� PERMIT <br /> Box 66 (1335 So Brown Rd) <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 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. 24 hour notice <br /> required. <br /> *******************,t**1***************************************************** <br /> JOB SZT$ ADDRESS: ��1 6 S ro <br /> Occupancy Type: ✓ esidenti Commercial <br /> OWNER'S NAME: ��t.,�GS Phone No. : <br /> Mailing Address: �e�f �X City: ��a„� <br /> ---r--- <br /> CONTRACTOR'S NAME: Yde. f-/ f Bu s. No. : S`�S �5'� <br /> Mailing Address: ut.Z �d e d S City: $v� .C.a4,T a.r- <br /> Master Plumber's State License No. : M �q�� City Cert. No. : <br /> *************************************************************************** <br /> PLUMBING FIXTURE SCHEDOLE <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 /> ------------- ----- --------- -------- ----- -------------- �------- --�-- --------- ---- <br /> Water Closet Laundry Tray <br /> Lavatory Washer <br /> ------------- ----- --------- -------- ----- -------------- -------- ----- -------- ----- <br /> �� <br /> Bathtub Water Heater g� <br /> ------------- ----- --------- -------- ----- ------^------- -------- ----- -------- ----- <br /> Shower water Softner <br /> ------------- ----- --------- -------- ----- -------------- -------- ----- -------- ----- <br /> Kitchen Sink Misc. (list) <br /> ------------- ----- --------- -------- ----- -------------- -------- ----- -------- ----- <br /> Disposal <br /> ------------- ----- -------- -------- ---- -------------- -------- ----- -------- ----- <br /> Dishwasher <br /> ------------- ----- --------- --------' ---- -------------- -------- ----- -------- ----- <br /> Wet Bar <br /> ------------- ----- --------- -------- ---- -------------- -------- ----- -------- ----- <br />� Sillcocks <br /> ------------- ----- --------- -------- ---- -------------- -------- ----- -------- ----- <br /> Floor Drains A�� <br /> u �- ,� <br /> ------------- ----- ------ ---- -------------- -------- ----- -------- ----- <br /> �,� --- <br /> Sump Pump <br />� Sewer Ejector <br /> ******************************** ****************************************** <br /> 1. Fixture Fee The minimum permit fee is $30.00 $ � `v <br /> Compute number of fixtures x $4/fixture <br /> 2. State Surcharge $ . 50 <br /> 3. Postage & Sandling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ � o0 <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 Minnesota, and certifies that all statements made on this <br /> application are complete, tr��d cornrec . /' <br /> Signature of Applicant: �Q +�� � Date: 7��olyt.r <br />� <br />