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LU.. Uv �1.i�� .,� Li��.,il i.U/ <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. <br /> 24 honr notice reqnired. <br /> *************************************************************************** <br /> JOB SITE ADDRESS: /,S/O Green (fcC <br /> Occupancy Type: v� Residential Commercial <br /> OWNER'S NAME: �cc�e �;c,Earc� Phone No. : y� - fci9 <br /> Mailing Address: i,sio ��r« 7�cr City: O�c„o <br /> CONTRACTOR'S NAME: �a �..7 6 Z� Bus. No. : 7 86• .�95/ <br /> Mailing Address: �y2� /��,/,,datl�/ / City: [�o, �?� ;r/, Zip: „s� ,� <br /> Master Plumber's State License No. : 3 7,l7 City Cert. No. : <br /> *************************************************************************** <br /> PL[JMBING FIXTURE 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 /> ------------ -+----- ---T----- ------ --- - <br /> � � �������� ���� '���r���� ��������� ����� <br /> Water Closet / � Sewer E ector <br /> ------------- ---- -`-—---- ---— ---- ------ -------]----- ---- ---�----- --------- ----- <br /> Lavatory / ° Laundry Tray <br /> Bathtub Washer <br /> ------------- -----�-------- ------- ------ ------------- ---- --------- --------- ----- <br /> Shower / Water fieater <br /> Ritchen Sink ' Water Softner : <br /> -------------�---- --•----- -------- ----- ------------ -- ------- -------- ---- <br /> Disposal �_ Wet Bar <br /> Dishwasher--- ---- ------- ------- ------ Sump Pump---- ---- ---•---- --------- ----- <br /> _____________1_____ ____-___ __�___ ____ ___________ __ ______ ________ ____ <br /> Sillcocks Misc. (List) <br /> Floor Drains <br /> ------------- ----- ---�---- --------- ------ ------------- ---- -------- ---------- ----- <br /> *************************************************************************** <br /> 1. Fixture Fee The minimum permit fee is $30 .00 $ �D. �v <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 PBRMIT FEE (add lines 1-3 above) $ ,3 j�.�U <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: /��` �� �a `•— Date: ` �.�� �� <br />