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� �TY OF ORC:IO �PPLiC�TION �OR PI.UMBING PER.yIIT <br /> C � <br /> Box 66 (1335 So Brown Rd) J?(o � <br /> Crystal Bay, MN 55323 ' ` <br /> *************************************************************************** <br /> General Iastrnctions <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 received. <br /> 3. Permits are not valid until 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 contractors only. <br /> 6. When any new construction or remodeling is invol ved, 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***,t**,t*****,t******�*******�****.***************** ******************* <br /> �� �I <br /> Jos szTE �innx�ss: ��; S -{- ,�- ,'', t�i, v�:���;1 fi�.'�,,�� .l ' � - : <br /> - Occupancy Type: _/, Residential Commercial <br /> OWNER'S NAME: f � � " Phone No. : <br /> Mailing Address: "_ " �� - , y' City: :-, '1/}y�f� <br /> I 1 ��_ ,_� ��� <br /> CONTRACTOR'S NAME:� �, Q� I' C41_ C f??'��. 1 � t('- Bus. NR <br /> Mailing Address: �r�'" ��-�� ����I �� City: �f V). Zip: -��,� <br /> Master Plumber's State Lice�ise No. : ��;'--�!� City Cert. No. : <br /> � *****************************************************.****�***�r************* <br /> , PLIIMBING FIXTIIRE SCHEDIILE <br /> � (Show number of fixtures of each tyFe on each floor) <br /> FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER <br /> ------------- --�---- ---r----- ------ ------------- --------- ----- --- <br /> T----I- r- <br /> Water Closet Sewer Ejectorl � � <br /> _____________!____�________ ____ ____I______ _____________�____ ___._____ _______________ <br /> Lavatory ! ' Laundry Tray i <br /> ------------- �-------—---- -------- ------ -------------I---- ---•----- ---------�----- <br /> i <br /> � - , <br /> � ' I Washer -----� , <br /> Bathtub � I � � '. <br /> � �_��_��������1_�����_�������� ��_ _����� ��__�____���� � �_��-�_�� __�� ��_�� <br /> r <br /> Shower � � i Water Heater i ' <br /> ,... . � � --I----- <br /> . -------------�--------•------------- ------ -------�-----�---- ---•----- ------- <br /> � � <br /> � Ritchen Sink ! � Water Softner ; � _I_- � <br /> _ . , , , 1 ' ---- <br /> ---------------------------;-------- ------ --------------'--- ------ - r- <br /> Disposal Wet Bar � <br /> � <br /> ------------- -----;------ ------- ------ ------- - <br /> Bishwasher �I � Sump Fump <br /> . 1��_��j_�'_'��� ,�_'.���__ ����_� __��___���_�� ���_ ��____� �__���_��� �_��i <br /> . - Sillcocks � � Misc. (List) <br /> � Floor Drains � <br /> ------------- ----- ---�---- --------- ------ ---- <br /> ******************************************************************�r******** ' <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 /> . " f ' <br /> 3. Postage & Handling (Only mail-in applications) $ 1.50 <br /> . , s <br /> 4. TOTAL PERMIT FEE (add lines 1-3 above) S � ` <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 nd correct. � <br /> � i <br />' . � . � <br /> : <br /> �� %� � �i��.� Date: J �� �'�� '1 <br /> Signature of Applicant: � � <br /> � .: <br />� { <br />