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(,1'1'Y UN' URUNU 1,YYLl(:ATION FUR PLUMBiNG Y�RMl'P ' `���� <br /> Box 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 fn 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 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 hour notice required. <br /> ********************************** ******** ******************************* <br /> JOB SITE ADDRESS: �c`'� i l-'c• F�- '� f -'f <br /> Occupancy Type: Residential Commercial <br /> OWNER'S NAME: Yr�` � ������`�" Phone No. : �%�� ���`��� <br />� Mailing Address: City: c; -�.,�<'> <br /> / > <br /> � , <br /> CONTRACTOR'S NAA'IE: '�" ��r.���� f' ��`' Bu s. No. ; 3 �S %�5'r: <br /> � <br /> Mailing Address: �"G � �,_�;- �,,,L.,����>> c.. � City: ���� Zip:�� � <br /> Master Plumber's State License No. : �-' � ' � City Ce t. No. : <br /> *************************************************************************** <br /> PLUMBING FIXTURE SCHEDULE <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�ector <br /> ------------- ----�---—---- ---- ---- ------ ------------- ---- ---��---- --------- ----- <br /> Lavatory � Laundry Tray <br /> ------------- ---- --- ---- --- -- - - <br /> Bathtub � Washer <br /> Shower------- ----- ------- -- ' ---- ------ Water_Heater- -�- ---•—--- --------- ----- � <br /> Ritchen Sink 'I � -_---_ Water Softner <br /> -------------+---- -�----- ----�---- ------------- ---- --�---- -------- ----- <br /> Disposal I_ Wet Bar <br /> -------------1 --- ---- ----- ---- ----------- -- --�---- -------- ---- <br /> Dishwasher-__I` 1 Sum Pum <br /> --------- 1 --- --- -- ----- -- ---- --p----p--- -- ------- --------- ---- <br /> Sillcocks Misc. (List) <br /> Floor-Drains- -____ __ ..____ ___.._____ ______ �y�,'�/jy�--�-'--- �-- ---�--- ---------- ----- <br /> *******************ir********************************ir********************** <br /> l. Fixture Fee The minimum permit fee is $30.00 $ `!7 � „�� <br /> Compute number of fixtures /� x $8/fixture <br /> x $5/fixture reset <br /> � �D��'�' <br /> l- _�c"'H.'r' v� �cyi,��1 ec 7��C �� $ .5 0 <br /> 2. State Surcharge <br /> 3. Postage b Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL P$RMIT FEE (add lines 1-3 above) $ ���_`� <br /> � �,1' ��' <br /> *************************************************************************** <br /> The undersigned hereby applies to the City of Orono for issuance of a Plumbing Permit, <br /> agreea 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 co rect , <br /> .� -�� <br /> ,l _ `,�,� � ,� , � <br /> Signature of A�:plicant: ✓ �" Date: �7' �' �`l <br /> i <br />