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l.iit� UL� I�YZt.i�CJ t]��Li�.�ii'vil i Vi2 i�aU.'��.T17 �.:.�."�y�i <br /> Box�66 (1335 So Brcwn Rd) <br /> . t <br /> ,� ` Crystal Bay, MN 55323 <br /> *************************************************************************** <br /> General Instrnctions <br /> 1. You r�ay 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 /> Pe_^.nit cards aill be sent by return mail the same da1 the application is received. <br /> 3. Permits are not valid until you zeceive 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 seoarate building permit must <br /> be obtained. <br /> , 7. All work r,iust be done in accordance with State Code requirements. <br /> 8. All work must be inspected before it is covered. Call 473-7357. <br /> 24 hoar notice reqnired. <br /> *************************************************************************** <br /> JOB SITE ADDRESS: � �. � � "'�= <br /> - Occu�ancy Type: � Residen ial Commercial <br /> OWNER'S NAME: /�Z���^�� `� `� _ Phone No. : ��7 l - � � '� 7 <br /> Mailing Addres s: �< ��� �k r� � << � � City: � �-;,���• r r F= <br /> CONTRACTOR'S NAME: ����"'Z` C%' ��'�� Bu s. No. : G-j 7 ��-`� `� �C� <br /> Mailing Address: �3 =�'� :a �v��� r .z �� [-.���, � City: �2-rc����� r� Zip:,-��� ,�,� <br /> Master Plumber' s State License No. : ��= 7 �� <br /> City Cert. No. : �tr� <br /> *************************************************************************** <br /> PLIIMBING FIXTIIRE SC3EDIILE <br /> (Show number of fixtures of each ty�e on each floor) <br /> FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER <br /> ---+-----^--------- ----------- --------- --�----- <br /> -------------1--�-�- i . <br /> V:atez Closet I , �Sewer Ejectorl <br /> __________y____�________ ____ ____I______ __________________ ___._____1=====____ _____ <br /> i i � � �Laundry Tray � <br /> Lavatory � � I I � � <br /> Bathtub ----- I----f--—----;---------i------�Washer-------�----I---•----- --------------- <br /> � I ------ tdater_fieater-I----�---•—--- ---------! ----- <br /> Shower-------I-(---i-------i-- --- - 1----- ------ <br /> ._ . -------- ---•----- ------- ---- -� <br /> ----- � � <br /> Ritchen Sink � I IWater Softneri � <br /> � �������������..��������.�_���� ����������������������������1���� ���.����� ��������������� <br /> Bisposal Wet Bar �- � <br /> � <br /> ������� ������ ������������� ���� ������� �������� j <br /> ����� <br />� ������������� �����r������� � <br /> Bishwasher i ' Sump Fump � <br /> -------------5---- ----- --- -------- ------ ------------- ---- ------- ----------�----- <br /> Sillcocks f � Misc. (List) <br /> : ------------- -----L---�--- -------- ------ ------------- ---- ------- ---------- ----- <br /> Floor Drains <br /> ------------- ----- ---�---- --------- ------ <br /> ------------- ---- -------- ---------- ----- <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 /> 2. State Surcharge $ '50 <br /> - 3. Postage & Handling (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 and cor�eEtZ <br /> �'-�'' <br /> ; . <br /> , _ <br /> _ ;, � = _ <br /> � / <br /> . / % �� � <br /> �-. --L = ` Date: - `' � / <br /> Signature of Applicant: , <br /> i <br />