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CITY OF ORONO APPLICATION FOR PLUMBING PERMIT <br /> ox 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 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 required. <br /> *************************************************************************** <br /> JOB SITE ADDRESS: _� '7 �C> ✓��✓i vt:�5 7'0 �� cz� v� <br /> Occupancy Type: t/ Residential Commercial <br /> OWNER'S NAME: ��S Cr~J Phone No. : � 7 � {�,��"�� <br /> Mailing Address: _1��,2� City: <br /> CONTRACTOR'S NAME: ���-,- �i/=x;�� Bus. No. : �-( 7 J-`j`j�L <br /> Mailing Address: -� � �<� j�/��r,-��,�- 1.�;z -� City: /�7C;�L�'�� Zip;�y;�3�J <br /> Master Plumber's State License No. : �3� � �,� City Cert. No. : <br /> *************************************************************************** <br /> PLUMBING FIXTURE SCHEDIII,E <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 /> ------------ ----a----- ---�----- ------ ------------- ---- --------- --------- ----- <br /> / Water Closet � � Sewer E ectar ;; <br /> a �� -------------�---- ��'�'--- ---- ---- ----- -------J----- -- ---�----- --------- ----- <br /> Lavatory 1 Laundr� T � t <br /> _ ' <br /> J� ---- ��'�-- -------- ------ ---1�r�� .- �`�'�- ---�----- --------- ----- ; <br /> Bathtub �v_ r _-_--_ Washer � <br /> ------------ -----�--��-�- ----- ----------- -- ------ ------- ---- <br /> - , - - - - - - - - - - - - <br /> Shower Water Heater <br /> Kitchen Sink- ----- � 1�� --�---- ------ Water Softner ---- ---.----- --------- ----- <br /> -------------�---- - - -------- ---- ----------- ---- --------- -------- ---- <br /> Disposal I_ Wet Sar <br /> ------------ -� --- ---- ----- ---- ----------- -- --•---- -------- ---- <br /> Dishwasher I- Sum Pum <br /> ------------ •1 --- ---•-- ------ ---- --p----P--- -- ------ -------- ---- <br /> Sillcocks � Misc. (List) <br /> Floor Drains <br /> *******,t*******,t***************************************,t************,t**,t*** <br /> 1. Fixture Fee The minimum permit fee is $30.00 $ <br /> Compute number of fixtures x $5/fixture <br /> x $3/fixture reset � <br /> 2. State Surcharge $ .50 <br /> � <br /> ' 3. Postage & Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) $ ��j.� , �� <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 /> , / <br /> Si nature of A , licant: �5��7�"" Date: `J � �—�/ <br /> g �p <br /> ' ��; .�' , .� <br /> ,.. ,�>. . '�`. <br />