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, ` CITY OF ORONO APPLICATION FOR PLUMBING PERMIT 3� ,a'� w'; Bc�x 66 (1335 So Brown Rd) 4�` � � C�;.,tal Bay, MN 55323 � • *******�r�***************�************************************************** Genezal Instractions . 1. You may app1Y for plumbing permits by mail or in person at the City offices. 2. Mailed in applications are sub ject to the postage and handling fees ahown below. • Persnit cards will be sent by return mail the same day the application is received. � 3. Permits are not valid �til yon receive a permit card. 4. Work must not begin unless the permit card ia available on the job site. 5. Plumbing permits may be issued to licensed contractora only. , 6. When any new construction or remodeling ia involved, a aeparate building permit must be obtained. � ' 7. A1 1 work muat be done in accordance with State Code requirements. �� 8. AI1 work must be inspected before it is covered. Call 473-7357. �E v 24 honr notice reqnired. � Z �� ****************************************************************�t********** Jos szT$ Annx�ss: :�9C� /-lc,/l rrr� � riacl ::� Occupancy Type: jc. Residential Commercial OWNER'S NAMS: �c.�r��`�' t'�C�DL? 1 m i�'"'� Phone No. : Mailing Address•�(o i C� -�r, �� City: _aTv�z- rA t-�n tZ- "��Q I CONTRACTOR'S NAM}.,': _ - �U BLS. No. : �133`�i�/7 � ,� Mailing Address: ��i t�:�n��,kc-� �� ' � ' -� City: M..��nc-f-cnlcr. Zip:5�3�j Master Plumber`s State License No. : M I`�lb� City Cert. No. : ***************************�*********************************************** D _Q1J+.-i�1'� � '�=- PLIIMBING FIXTIIR$ SCHEDIIL$ (Show number of fixtures of each type on each floor) FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER � ---- ----+----- --- ------ ------------- ---- --------- --------- ----- ---�--------� � __=----- --- Water Closet Sewer Ejector ------------ -� � ---—---- - � •---- ------ ------------- ---- ---•----- --------- ----- Lavatory h ' � Laundry Tray � I Bathtub --- �/T--O---T -�--- ------ Washer------- -�-- ------- --------I ----- --- - ---- - Shower �/� Water Heater 1 � � _�,,_ ---- ----- �� --- ------ ------------- ---- ---^----- ----- ------------- - - .: __. Ritchen Sink � water Softner � ------------- ---�------- ------- ------ ------------- - -------- --------- ----- Disposal � Wet Bar ------ — ------------- ----- % Sump Pump _.-__ __._ Dishwasher Sillcocks--- -�- --•--- -------- ------ Misc-_(List)- -/-- -�'n -�t��-- rt`�tCclt.yn,t�rt'Gi� L - Floor Draina J � ---- ------ ------------- _ r/U n'1_ � ��'_� -_-- - ---�=--- --- - � ----****,t*****,t***,t*******,t*******,t*************** *�t* ir*�l��e,rir**,t,t�*x*x - **** � ' 1. Fiatnre Fee The minimum permit fee is $30.00 $ � �C�l� _ Compute number of fixtures � x $5/fixture __ _ . __. _ _ - x $3/fixture reset �_ _ - = -= - �2. State Surcharge . $ .50 � ... . - � �. :.-- --•�.".._ ._ . _�. .,_. ._.. _ . _ _.. _ _. . _.. ...- , -- - - , _, , .___ . _ _.: ,-�-- " �-�-"�3. `Postage & Handling (Only mail-in applications) $ ''-- "-1.50 .. 4 TOTAL PERMIT FEE (add li*********bo***************�***�** -� - ~ li _ -- - - - _ - �� - �**************************** ************** -. ' The undersigned hereby appliea to the City of Orono for isauance of a Plumbing Permit, __ - agzeea to do all work in strict accordance with the ordinances of the City and the regulations of the State of Minneaota, and certifiea that all statements made oa this application are complete, tzue and correct. - - --- - • - - _ - - .� ,. ___ _ - - ---- - . .__,._ - - __ --- ._ _... -- -= - _ � /i_ /� Signature of Applicant• / .lo��`)`t� ��"� `�-" - - Date:1�-� -�/(�- 7�� -