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� C�TY OF ORC�O �PPLiC�TION �OR PLUMBI�G PERMIT <br /> Box 66 (1335 So Brown Rd) <br /> Crystal Bay, MN 55323 <br /> ` �� **********�**************************************************************** <br /> General Instrnctions <br />� 1. You may apply for plumbinq 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 /> Perr.iit cards will be sent by return mail the same day the agplication is received. <br /> 3. Permits are not valid until yon 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 /> ***************************************************�r*********************** <br /> JOB SITE ADDRESS: j,� 7 C� �����¢� ������ ��� <br /> �-- Occupancy Type: ��_Residential �Commercial <br /> OWNER'S NAME: �%lL /���v�..� Phone No. : ��j ' ����� <br /> Mailing Address: 1,�,2yz,•a;� City: �„2�,�.d <br /> CONTRACTOR'S NAME: �U���- � �, �-i<L l-c�, Bus. No. : ��Z `� - ' -�`�[� <br /> Mailing Address: �,�..�% v x r£�n-� -�, - City: ?�.✓� i. Zip: . 5 �!-t L <br /> Master Plumber' s State License No. : City Cert. No. : <br /> *************************************************************************** <br />.- , PLIINIDING FIXTIIRE SCHEDIILE <br /> � (Show number of fixtures of each tyFe on each floor) <br /> FIXTORE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER <br /> � ------------- �----- --T----- ------ ------------- ---- --------- ------- -- <br /> T-------- r- r--- <br /> S:ater Closet � � �- ___ Sewer Ejector � � <br /> ��__��_�___��y _�_�__���__��'_��_ I �� ��__����__��� ���� ���.����_T�___����� _���_ <br /> .���_� !f �.T�d'=^G�'"v T=aV I I � <br /> LavatoryI �--—--- 4 -�----1------ ------------- ---- ---�-----� ---------�----- <br /> -------------i---- ' --- <br /> Bathtub � � ` Washer I I <br /> � ___�_��__��_�1��_��_�����_�1.�_ ��� �_���_ ��_��__������ ��_�� _���_��_�I�__�� <br /> � , � Water &eater � <br /> Shower � � <br /> :. : � � --- ------ -------------�---- ---�----- --------------- <br /> i <br /> --------------'--------•---------- <br /> I-:. - ._.�, Ritchen Sink � Water Softner <br /> - -------------------=-------�--------------- -------------1 X 1------------------'----- <br /> Disposal � Wet Bar � <br /> -------------1---- :. ----- -------.1------ ------------- ---- ---.---- � ---------�----- <br /> , _, _ � � <br /> Dishwasher ; � Sumo Pump <br /> -------------1---- I --- --- ---------�------ ------------- ---- ------- ----------�----� <br /> . Sillcocks � + Misc. (List) � <br /> ------------- ----- --- <br /> ; <br /> Floor Drains <br /> ------------- ----- ---�---- --------- ------ <br /> *************************************************************************** ' <br /> 1. Fizture Fee The minimum permit fee is $30.00 $ ?L� � � <br /> Compute number of fixtures x $5/fixture ± <br /> x $3/fixture reset ' <br /> , <br /> , <br />• � - 2. State Surcharge $ .50 ;� <br /> . i <br /> 3. Postage & Handling (Only mail-in applications) $ 1.50 �� <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 /> _ /� <br /> . . .• ' ,,�....�� �'.r--`� Date: �' / _' C�` y <br /> Signature of Applicant: <br />� <br />