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. CZTY OF ORC�O aPPL�C�TION FOR PLUMBING PERMIT <br /> Box 66 (1335 So Brown Rd) <br /> ' Crystal Bay, MN 55323 <br /> *************************************************************************** <br /> General Instrnctions <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 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 reqnired. <br /> *************************************************************�r************* <br /> JOB SITE ADDRESS: /S f��� ,�d N�� .�.��� ���v�� <br /> - - Occupancy Type: x Residential Commercial <br /> OWNER'S NAME: ^/,��� ,�o�/f_�- Phone No. : <br /> Mailing Address: /S8'o .�c�t ��,�.� /;��.� City: �'1,Cpn��* <br /> CONTRACTOR'S NAME: iQd i�/.0��.�d �i�G�� Bu s. No. : L��y�ss�y <br /> Mailing Address: �( �_? �zaln��� C'�,� City: �`i/9p,�� ,�,Ka�iP:�,�Gy <br /> Master Plumber' s State License No. : �3g'7 3 City Cert. No. : <br /> *************************************************************************** <br />: .. PLIIMBING FIXTIIRE SCHEDIILE <br /> � (Show number of fixtures of each ty�e on each floor) <br /> FIXTURE TYPE BSMT 15T FLOOR 2ND FLOOR OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER <br /> ------------- �----- ---r----- ------ ------------- ---- --------- ----- - <br /> �----�--- r- <br /> �:ater Closet � � �- �_ �_ Sewer Ejector�- j j <br /> --------------�----�---—----I -- --- ----- ------Y----y --- ---•----- -------------- <br /> Lavatory � ' I Laundr Tra j � ' <br />_ . -------------�---- � --—----�--�----�------ ------------- ---- ---•----- ---------�----- <br /> Bathtub i � x Washer ( � <br /> ------1- --------I-- --- ------ ------------- --- ---^•--- ---------r----- <br /> " ------- - <br /> Shower � I Water fieater I �- � <br /> . .. -------------;-------•-----i------- ------ --------------t---- --�----- ---------�----- <br /> :�. -.._.�, Ritchen Sink ; � I Water Softner <br /> - . _ ___ _�___________ _____________1____1________ _________�_____ <br /> _____________________ _ ___ <br /> , . <br /> Bisposal I I Wet Bar I � <br /> -------------1---- ----- ------ ------ ------------- ---- ---•--- --------- ----- <br /> -�- - <br /> Dishwasher �+ �' Sumo Pump I <br /> � ��-���-������1-�-- -'— ��� �'_.��-� -�-�-� -�--��-����-� ���� ��----� ������--��t.-���� <br /> . ._ . Sillcocks � Misc. (List) <br /> � Floor Drains <br /> ------------- ----- ---�---- ---�----- ------ <br /> *************************************************************************** <br /> 1. Fixture Fee The minimum �ermit fee is $30.00 $ <br /> Compute number of fixtures x $5/fixture <br /> : -, x $3/fixture reset : <br />_..;-:�',::: <br />• - 2. State Surcharge $ .50 <br /> - 3. Postage & Handling (Only mail-in applications) $ 1.50 <br /> . . , <br /> 4. TOTAL PF.RPIIT 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 /> I <br /> Signature of Agplicant: � ' � � Date: �� � � �L_ ? <br />�_ <br /> � <br />