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NO t ,�,�� APPLICATION FOR PLIIMBING PERMIT <br /> 35 So Brown Rd) � <br /> 3ay, MN 55323 <br /> ,. ..�*.. :K****************************************************************** <br /> ' t�eneral 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 day the application is received. ` <br /> E <br /> 3. Permits are not valid until you receive a permit card. <br /> 4. Work must not begin unless the permit carc�: 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. A1 1 work must be done in accordance with State Code requirements. <br /> 8. All work must be inspected before it is covered. Call 473-7357. 24 hour notice <br /> required. <br /> *************************************************************************** <br /> JOB SITE ADDRESS: 353� � y�l/� <br /> Occupancy Type: Residential Commercial <br /> OWNER'S NAME: � �� ����� Phone No. . / l � —</D�/ <br /> Mailing Address: ��� City: �Z T� <br /> ! CONTRACTOR'S NAME: � U(�' j �i-G'i 7�� (� Bu s. No. : 5�1��C <br /> Mailing Address: 5 ��___ _ City: <br /> Master Plumber's State License No. : City Cert. No. : <br /> ***************************************************�*********************** <br /> PL01�4BING FIXTURE SCHEDULE <br /> (Show number of fixtures of each type on each floor) <br /> FIXTURE TYPE BSMT 15T FLOOR 2ND FLOOR OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER <br /> Water_Closet -�-- --------- -------- ----- -Laundry TraY- ---�--- ----- -------- ---- <br /> � Lavatory / ---_ Washer ! <br /> ------------- -{--- --------- -------- - -------------- -------- ----- -------- ----- <br /> Bathtub , Water Aeater <br /> ------------- ----- --------- -------- ----- -------------- -------- <br /> Shower Water Softner <br /> ; Kitchen_Sink- --�-- --------- -------- ---- Misc�-(list�- -------- ----- -------- ----- <br /> Disposal <br /> ; ------------- ----- --------- -------- ---- -------------- -------- ----- -------- ----- ;: <br /> Dishwasher <br /> Wet Bar <br /> ------------ --- -------- -------- --- -------------- -------- ----- -------- ----- � <br /> Sillcocks <br /> ------------- ----- --------- -------- ---- -------------- -------- ----- -------- ----- ; <br /> ; Floor Drains s <br /> ------------ � ------- ------- --- -------------- -------- ----- ------- ----- a <br /> Sump Pump <br /> -0 sewer Ejector <br /> ******************************** ****************************************** <br /> 1. Fixture Fee The minimum permit fee is $30.00 $ 3 Z-•�(� <br /> Compute number of fixtures x $4/fixture # <br /> � <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} $ j� � � � <br /> °: ************tk**�k*1k******it*�t*�Ir*iF*************�tA'9k�k****�k*tk*�k****i�***it*****�lr�k** <br /> The undersigned hereby applies to the City of Orono for issuance of a Plumbing Permit, r <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 a co ect �y�� . <br /> g PP �,� �� X ___ __... , <br /> Si nature of A licant: �j '�� Date: �' � <br />