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^�TY OF ORCNO r�PPLIC.�TION �OR PLIT�IBI.'�IG PERIrIIT <br /> +� ' Box 66 (1335 So Brown Rd) <br /> Crystal Bay, MN 55323 <br /> *************************************************************************** <br /> General Znstrnctions <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 da1 the application is receined. <br /> 3. Permits are not valid until yon receive a permi.t cazd. <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. AlI work must be inspected before it is covered. Call 473-7357. <br /> 24 honr notice reqnired- <br /> *************************************************************************** <br /> � , , . <br /> JOB SITE ADDRESS: ��i C� � � f��_��� s- ��''� - <br /> - . Occupancy Type: Residential y�- � Commercial <br /> � � ,���; r � � ����_--- Phone No. : `r �� - �, <br /> owrr�t s x�: (.,,�,�� � (� �.:_ ' ��� �` <br /> Mailing Address: - � City: �'� -u,-y.-r.— <br /> CONTRACTOR'S NAME: �� �'�"'e�., �-_ Bu s. No. : �=S_% 5--�. s�d" <br /> Mailing Address: -� i/,� � ' City: �4�-4.�.<.�.�-.- Zip: s3--�y c; <br /> �e'9�va-k-Q--e_. � <br /> Master Plumber's State License No. : i � � � City Cert. No. : <br /> ********************************�****************************************** <br />. - . pZ,IIMBING FIXTIIRE SCHEDIILE <br /> � (Show number of fixtures of each tyge on each floor) <br /> FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER <br /> --�----- ------------- - --------- ------ ---- <br /> �_ --- <br /> ------------- r--=�----- <br /> �4ater Closet _ Sewer Ejector� __ <br /> _____________1====�________ __ _ ____I===== _____________�__ ___._____ _________ _____ <br /> Lavatory � I Laundry Tray � <br /> ------------- '---- --—-------------�------ ------------- ---- ---•----- ---------�----- <br /> Bathtub ' � I -�_ Washer - --- ---�--- -------- I ---- <br /> � �__����������1��_����������1�_ �� ����� ���_��__��� � � _ <br /> — T <br /> � ( Water Heater ' <br /> _ Shower { � ---- I---- ---•----- ---------�----- <br />" . - Ritchen Sink ',/� �r � _�_-- _--_ Water-Softnerj_-_- I <br /> -----------------}-� -- --- - - - 1 ---^----- ---------=----- <br /> �_ <br /> Disposal I i Wet Bar � <br /> -------------i-----+;------ ------- ------ ------------- ---- ---•--- ---------�----- <br /> \� '' Sump Pump I <br /> Dishwasher � i �� <br />: . .. .. Sillcocks----1-----� ---- -- ------- ------ Misc-_(List?- --- ------- ---------- ----- <br /> ------------- ----1--- - - - <br /> .� Floor Drains <br /> ----- ------------- ---- -------- ---------- ----- <br /> *************************************************************************** <br /> 1. Fizture Fee The minimum permit fee is $30.00 $ <br /> Compute number of fixtures x $5/fixture : <br /> x $3/fixture reset <br />�";.;�"�.;:::. <br /> � -- 2. State Surcharge $ .50 ; <br /> s <br />� 3. Postage & Handling (Only mail-in applications) $ 1.50 = <br />_ , , i <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ � <br /> � � *�k*******yk�k�k*�t#�t*****�F�F**�'�t�r�k�t***�t**yk�lr*�F*�t**�t*�t*�t*�k�k*�Ic�k�k**�titir�t*ir**�t�t�k�t�k�t*** i <br /> The undersigned hereby applies to the City of Orono for issuance of a Plumbing Permit, ; <br /> agrees to do all work in strict accozdance with the ordinances of the City and the � <br /> requlations of the State of Minnesota, and certifies that all statements made on this + <br /> application are complete, true and correct. ; <br /> � <br /> . . ' i/J . / � �t <br /> � Signature of Applicant: 'u- � `�� ����' Date: �� � � �I � <br />