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� �- <br /> CITY OF ORONO j * APPLICATION FOR PLIIMBING PERMIT <br /> B�x 66 (1335 So Brown Rd) ,1 � � <br /> C�ystal Bay, MN 55323 % � �S <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 pon 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 se r�te b il �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: ; '�jSC�; �"%,,i. �1-�.,CI'l ll�:C�-� � �Z-v � <br /> Occupancy Type: k Residential Commercial <br /> , , <br /> OWNER'S NAME: ` �y�_;_-���• r��'\ Phone No. : L��C'7 -�(� ��� <br /> Mailing Address: i ��x� ��-c�r,r�� L-,C`�c-�• i� t�:zJ City: - � �-,- <br /> CONTRACTOR'S NAriL�`:-►C1� cv��r'1F-��,���a ���� ��i,; �� Bu s. No . (j�-5 j 11 � � <br /> Mailing Address: L�� t i�-t-�►��.Z,�-„-. c�L��. City: (`_< �. �, ct�a�1,�� ZiF ���',�� <br /> Master Plumber' s State License No. : 1�=\ \��,1��=-� City Cert. No. : <br /> **************************************************************** ********** <br /> PLIIMBING FIXTIIRE SCHEDIILF���i�'v�:�.r���-� <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 /> ������������� �� - ��������� ���T����� ������ ������������� ���� ����`.�.��� <br /> �� �������� <br /> � ���� <br /> Water Closet �- � �- ____- Sewer Ejector <br /> ------------ -- ---- --- --- ---------- -- --•---- --------�----- <br /> - , - - - - - - - - - <br /> Lavatory ��{ ' Laundrg �ra� � <br /> -------------�-----,--------�------- ------ ------------- -- ---�----- ---------L----- <br /> , - - - <br />� Bathtub � j Washer <br /> -------------�--�- ------ - -- ----- ------------ ---- ---^----- -------- ----- <br /> i - - - - - - - <br /> � <br /> Shower I I , _____ Water Heater -+_- I <br /> --------------�---- --•----- ----- - ---------- �j ---•---- --------- ----- <br /> -� - - - <br /> 1 ; <br /> Ritchen Sink f � _--__ Water Softner <br /> --------------------------- -------- - ------------- ---- --------- --- <br /> ------ - <br /> Disposal I- { __--_ Wet Bar <br /> -------------1 --- ---- ----- ----------- -- --•--- --------- ----- <br /> Dishwasher_-_ }_ Sump Pump <br /> --------- 1 ---- ----•--- -------- ------ ------------- ---- ------- ---------- <br /> � - -- <br /> SillCocks Misc. ;3,isLi f '�t•;;��; f�; 4�"}ci ��c`l i�����Z:. <br /> Floor Drains <br /> *************************************************************************** <br /> 1. 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 � Handlinq (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PSRMIT FEE (add lines 1-3 above) $ � �� , (;L: <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 /> Signature of Applicant: _�,{� _�1/��ly{,/�`� Date: �`Y-"�� ���� <br />