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j ' CITY UF ORUNU APYLICATION FOR PLUMBING PERMi'1' �/��/L., <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. <br /> 24 honr notice reqnired. <br /> *,t,t*******************,t********************,t***** ,t******************,t**** <br /> JOB SITE ADDRESS: Z 7 `� (�� � ` ,�,tJ�(',f' � � , <br /> Occupancy Type: �_Residential �^`Commercial <br /> � � <br /> OWNER'S NAME: f�1 �z �E�� � `' Phone No. : <br /> Mailing Address: �- 5 �o ,� City: � `����� , <br /> CONTRACTOR'S NAME: �'�Z.� L ,�"l_ �t.'�/�j�(; Bus. No. : � �F Z ' � �Y � <br /> Mailing Address: z 5 �� / 5_.% `�`- 2�� / City: ;,t�� �c:-,v, �a Zip: S �.� 87 <br /> Master Plumber's State License No. : /v/ z� Z �{ City Cert. No. : <br /> *************************************************************************** <br /> PLUMBING FIXTURE SCHEDUL$ <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 /> � ------------- ---- ----+----- ----r----- ------ ------------- ---- ----�---- --------- ----- <br /> Water Closet Z Sewer Ejector <br /> ------------- ---- ---—---- ---- ---- ------ ------------- ---- ---•----- --------- ----- <br /> Lavatory � Laundry Tray <br /> Bathtub � Washer <br /> Shower I _---- Water Heater <br /> Ritchen Sink -_--_- Water Softner <br /> -------------�---- -•---- ---•--- ----------- ---- ---�----- --------- ---- <br /> Disposal `_ Wet Bar <br /> -------------1 --- ----- ----- ---- ------------ ---- --•---- --------- ----- <br /> Dishwasher I_ Sum Pum <br /> -------------1 --- --- -- -------- ----- ---P----P---- --- ------- ---------- ----- <br /> Sillcocks Misc. (List) <br /> Floor Drains <br /> ��������.����� ����� ���i���� ���.r����� ������ �������������. ���� ���rr��� ���������� ����� <br /> *************************************************************************** <br /> l. 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 � Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAI, PERMIT F$E (add lines 1-3 above) $ . �� :, `�C' <br /> *************************************************************************** <br /> The undersiqned hereby applies to the City of Orono for issuance of a Plumbing Permit, <br /> agrees to do all work in atrict accordance with the ordinances of the City and the <br /> regulationa of the State of Minnesota, and certifiea that all statements made on this <br /> application are complete, true and correct. <br /> l <br /> Signature of Applicant: ''22��' Date: ��� Z 3 ' � � <br />