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� � <br /> CITY OF ORONO APPLICATION FOR PLUMBING PERMIT <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 ahown 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 muat 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************************************** <br /> JOB SITE ADDRESS: ��� ; ;� 1„(� �'I,,(�,� ;�- ��/ <br /> Occupancy Type: Residential Commercial <br /> OW`NER�� ��Fa: r! <br /> j�(�,(�") { U/t��l'YU��[�`���� Phone No. : <br /> Mailing Address: City: <br /> CONTRACTOR'S NANiE yR � ✓' )� � ��1 `� Bu s. No. : � � - -� <br /> 1,'� j 9 I��i ..:Tt.�ti.c �� I'`i/�A_r:6�C <br /> � Mailing Address �-�1��� r4^.!���„_p,i CT�.�k� 11�C=' Cit � � ` <br /> , Y� ��,�' ;,.G�i;�_� Zip: <br /> Master Plumber's State License No. : �r1 =�"i'j,Z- City Cert. 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 O'tHER <br /> ------------- ---- ----+----- ---T----- ----- ------------- ---- ---^--- ------- ---- <br /> Water Closet Sewer Ejector <br /> ------------- ---- -------- ---1 ---- ------ ------------- -- --�---- ------- ---- <br /> Lavatory 1 Laundry Tray <br /> ----- <br /> Bathtub / Washer <br /> ------------- ----- ------- ------- ------ ------------- ---- ---------- --------- ----- <br /> Shower Water Heater <br /> Ritchen Sink ' / Water Softner <br /> Disposal � Wet Bar <br /> Dishwasher �' Sump Pump <br /> Sillcocks Misc. (List) <br /> FloorDrains- ----- ---•--- --------- ------ ------------- ---- ------- ---------- ----- <br /> -------------1-----�---�----�---------.1------ -------------1----1---_-----�---------- ----- <br /> *************************************************************************** - <br /> 1. Fixture Fee The minimum �,ermit 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 � Handlinq (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ <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 /> � � <br /> Signature of Applicant: �VLt.c-�, r ��./����-- Date: �,/�/ �,� ; <br />