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CITY O� OROTZO APPLICATION FOFt PLIIMBII�� PERMI� <br /> Hox 6f: (1335 So Brown Rd) . <br /> � Crystal BayP Mld 55323 � <br /> �������a�r�*��r*�*,��������,����r*�,r*����**�r�**�*��*�,���r*�r***,�*��r,��**,��*,�*��*�*** <br /> Geaera� Iastrnctiioas <br /> 1. You may apply for plumbinq permits by mail or in person at the City offices. <br /> 2. M�il�d in spplicationa sr� sub ject to th� post�ge and handling fees ehown belowm <br /> � Permit cards will be sent by return mail the same day the application is received. ��� <br /> 3. P�r�fts sre aot va,l3d uatiT yon receive a pezait card. � C1 <br /> sr �j,� <br /> 4. S4ork muat not beqin nnless the permit card is availsble on the job aite. �jy <br /> 5. Plumbing permits may be issued to licensed contractors onlp. , <br /> 6. [4hen aay new constrnctioa or remodeling ia lavolveS, a aeparate buildinq permit must <br /> be obtained. • �' <br /> 7. A1 1 work muet be done in accordance with State Code requirements. <br /> 8. RT 1 r�osk must be inspected before it is covered. Call 473-7357. <br /> 24 honr aotice reqnized. <br /> *�***.*�*�r�*�r****,��***��r***�******************��**�**�******�*************** <br /> �oB s�� �nnx�ss: - ��'� ;j"' _. _.�Y�� ;ct/?,D �,�/. - <br /> Occupancy Type: Residential Commercial <br /> OWNER`� H�: �j�G`'.c-'`� /�I ss "� Phone No. : �//�% -• g E'/ � <br /> Mailing Address: City: <br /> COPITRACTOIt'S PI�}..': �.��� Go�`"�'E'� d�'6��'"' _ su s. No. : S�� .'�{'�� <br /> Mailing Address: �S �/o � C.-ri�%�SS � /g v� City:�id�.Vd�e/%�• Zip: �'S°�3-r <br /> Master Plumber's State License No. : /,�,P"6 City Cert. No. s <br /> ****�**��,�***�**�r*,�,�,�**************** ** *********,t*********�***�***�**�*** <br /> gLDr'lBING FIXTIIRE &CHEDQLB <br /> (Show number of fixtures of each type on each floor) <br /> FIXTIIRE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER FIXTIIRE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER <br /> -------- -- ��"--- ---r----- ------ ------------- ---- ---- --------- ----- <br /> Water Closet Sewer Ejector � <br /> -------- <br /> ----- ---- --�- ----�---- ------ ------------- ~-- ---•—---- --------- <br /> Lavatory � Laundry Tray <br /> ------------- ---- -- <br /> Bsthiub . Washer <br /> ------------- ---- ------- - <br /> . Shower Water Heater <br /> ------------- ---- •----- <br /> - _. . . ._.... <br /> Kitchen Sink - - water Softner • � <br /> ------------- ----- ---- <br /> • Disposal ' Wet Bar � <br /> ------------ ----- ------ <br /> Dishwasher Sump Pump ' <br /> Sillcocks__ -N-- ----- ------- ------ Misc--(List)- ---- ------- ---------- ----- <br /> Floor Draina <br /> ---- --+=--- --e�---- -- ------------- ---- -------- ---��r -- <br /> ***�e****�r�*�****�r**�,�*�r**�**�r**�******,t*********�********,e***************** - <br /> • 1. Fiature Fee The minimum penait fea is $30.00 $ . <br /> Compute number of fixtures = x $5/fixture <br /> _- = __ <br /> . . _. . _ x $3/fixture reset .:'__ _ : . . .�� . <br /> -2. State Snrcharge .. _ _ -- .- .. _ $ .50 -. -- : - <br /> , �_ <br /> �- - '=3:"sPcstage � Haadliag (Only mail-in applications)TS -- - 1.50��--� ; . <br /> . <br /> --- -- -. -., - - - - - - - <br /> - -• - .. <br /> . <br /> .._. _. -- --- � -_ _ _... ., _ _ . . . _ __ ... --- - -�-- <br /> - ---- � ,�__ ._: �. _.�.._.. . --.- --- - _ . __ � <br /> . 4. �-�� P$Rt�IT FEE (add Iines 1-3 abovel --._ - $ .- . `. - � <br /> - �-*�r*�rihit�k�k*****���k**tk*��k*�***********�*******�r�te**�r�k�r*�**�t�r�tdr�t�k*�k***�***�r��*�F •�•'� <br /> ' --•-�.a-�. --..r---- " - ..__ .._.. --__ . <br /> _... ,_ ._ ._.-.._._ —.�-- <br /> ' - -The undereiqned hersby applies to the�City of Orono`for issuance of a Pinmbing Permit��� ! <br /> sqree8 �o do s11� �ork in strict �ccordance �ith the ordiaances of the City��and the� _ _ <br /> regul�tions of the StBte of Minnesota, and certifies that all atatements mnde oa this _ <br /> �ppliaation azg complet�, true and correct. `� - `-� ' • =� <br /> ,_ . .. � __ . __._ __ _--- � - - - - ---- L� <br /> __. _.. .. - - - - - . <br /> __.. � `l s, � - ` .� <br /> Signature of Applic�nto - - -- Date: - <br /> ------- -- � -- -- - - <br /> - -- ---- - — <br /> ___ --.... � ._. . . __ . - _ -- . ._ .. . - - , . Y- - <br />