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� <br /> -� CITY OF ORONO APPI,ICATION FOR PLUMBIN6 PE�2MIT <br /> . Box 66 (1335 So Brown Rd) �c� <br /> Crystal Bay, MN 55323 �,/� �,103� <br /> *************************************************************************** <br /> General Instructions <br /> 1. You may apply for plumbing permits by mail or in person at the City officea. <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 separ�3te 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 /> *************************************************************************** <br /> JOB SITE ADDRESS: J�ubC�.s' T' /�/�/1G /` l����va �nn� .�'L �.0 <br /> Occupancy Type: Residential Co ercial <br /> OWNER'S NAME: �O�'r�::�7J` �},G'�'� Phone No. : <br /> Mailing Address: ���,a �-�ti-` L,2i� dTLi,'Q City: O,�?��✓, <br /> CONTRACTOR'S NAME: ��G L��,�)�f�'9C ._$`c:�G�� Bus. No. : �-�3 ���-� <br /> Mailing Address: �',3:r�,�?,��,�/,�n�° City: Lr�v� ����� Zip:� <br /> Master Plumber's State License No. : 3 � ).� City Cert. No. : <br /> *************************************************************************** <br /> PLUMBING FIXTURE SCHEDULB <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 /> _�_�___��___ �__�-1_____ ���T_�___ _____� _�_____�_���� __�� ___..�-���� _________ _���� <br /> Water Closet Sewer E ector <br /> ------------- ---- ---—---- ---- ---- ---- ------�---- -- --�---- ------- ---- <br /> , Lavatory Laundry Tray <br /> ------------- --- --—--- ------ ---- ----------- -� --•---- ------- ---- <br /> Bathtub Washer <br /> � ------------- ----- ------- -- --- ------ ------------- ---- -�--^---- --------- ----- <br /> 'j <br /> Shower Water Aeater <br /> Ritchen Sink 'I ------ Water Softner <br /> -------------+---- --•----- -------- ----------- -- --�---- -------- ---- <br /> Disposal I_ --_--_ Wet Bar <br /> -------------1 --- ------ ------ ---------- -- --�---- -------- ---- <br /> Dishwasher___ I_ Sum Pum <br /> --------- •1 --- ------ ------- ---- --p----p--- -- ------ -------- ---- <br /> Sillcocks Misc. (List) <br /> Floor Drains <br /> *************************************************************************** <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 /> , \ <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 an8 correct. <br /> Signature of Applicant: Date: <br /> ,-, , - �, <br /> .• <br /> , . .,,_ `; .. `i�' _ <br />