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h�� �3 <br /> ; • <br /> 1 • CITY OF ORONO APPLICATION FOR PLOMBING PE.r^MIT <br /> � Box 66 (1335 So Brown Rd) <br /> � Crystal Bay, MN 55323 <br /> � ***********************************************************,**************** <br /> � General Znstrnctions � � <br /> 1. You may apply for plumbinq 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 /> iPermit cards will be sent by return mail the same day the application is received. <br /> 3. Permits are not valid nntil yon 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 contractora only. <br /> ` 6. When any new construction or remodeling is involved, a aeparate building permit must <br /> � be obtained. <br /> 7. All work muat 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********************** <br /> JOB SITE ADDRESS: _��� �,��,(,�(E'-IL� ���.'P�, �t.7�t3� �� <br /> Occupancy Type: x Residential Commercial <br /> OWNER'S NAME: ��� �t�S 1'�C��� Phone No. : /� <br /> Mailing Address': ��;30 L�,,K'� ��?�,� � ��— City: ,�� <br /> CONTRACTOR'S NAME: D Bu s. No. : �5� -/S l� � <br /> Mailing Address: /95� City: c Q i�j�� Zip: 5<5 �� <br /> Master Plumber's State License No. : /yy_S City C t. No. : <br /> *************************************************************************** <br /> PLUMBING FIXTURE SCHEDULE <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 /> ------------- ---- ----+----- ---�----- ------ ------------- ---- ----•---- --------- ----- <br /> �9ater_Closet_ _ j ___�_- ____ -_- _--- Sewer_Ejector __:��-_ -_____- ____ <br /> - - - - - - - ---- - - - - - <br /> Lavatory � � -_--- Laundry Tray � <br /> ------------ --- --�-- - -- ----------- -- --•---- ------- ---- <br /> Bathtub � Washer � <br /> Shower------ �-- --•�--- -`--- ---- Water_Heater - I- ---�--- -------- ---- <br /> Ritchen_Sink_�__-_ -_ ( ___ __`-_-_ -_-__ Water_Softner �_ -_ __ ____-_-_ _-_- <br /> Disposal-----1----- - � -- ----- ---- Wet_Bar----- -- --•--- -------- ---- <br /> Dish�+asher ' Stimp Pump <br /> Sillcocks �� — r -- - -- Misc. (List)- ---- ------- ---------- ----- <br /> Floor Drains <br /> ------------- ----- ---�=-- -------- ------ ------------- ---- -------- ---------- ----- <br /> *************************************************************************** <br /> ��� � � <br /> 1. Fiatnre Fee The minimum permit fee-�s $30.00 $ -�— 15a,�,Tz7 <br /> Compute number of f ixtures /9 x $'�/f ixture <br /> x $3/fixture reset <br /> 2. State Surcharge $ .50 <br /> 3. Postage � Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PffitMIT FE$ (add lines 1-3 above) $ -S¢�-� /_`�'�•c7a <br /> *************************************************************************** <br /> The undersigned hereby applies to the City of Orono for isauance of a Plumbing Permit, <br /> agrees to do all work in atrict accordance with the ordinancea of the City and the <br /> regulationa of the State of Minneaota, and certifies that all statements made on this <br /> applicstion are complete, true and correct. <br /> Signature of Applicant: /)���n � �� ��"'���� � � Date: �"�y��� � <br />