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t � CITY OF ORONO "�"�'2� <br /> t APPLICATION FOR PLUMBING PERMIT <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 in person at the City offices. <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 muat 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 honr notice reqnired. <br /> ****************************************rt** ******************************* <br /> JOB SITE ADDRESS: � � /� ��' � - p � � <br /> Occupancy Type: �" Resi ential Commercial <br /> OWNER'S NAME: _� "" Phone No. : <br /> Mailing Address: � City: �-y_�"�.��-�� <br /> CONTRACTOR'S NAME: Ll.��'r�j 5 S't� f t.. d�✓' �' Bus. No. : � oL� �'��,,3 �1 <br /> Mailing Address: � �E,� �'E��'�,��5 �uf. -5:v . City: ::'i- ��.�;�,s . ip; � � t� <br /> Master Plumber's State License No. :�ic�; � City Cert. No. : <br /> *************************************************************************** <br /> PLUMBING FIXTURE SCHEDULE <br /> . (Show number of fixtures of each type on each floor) <br /> FIXTDRE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER <br />� ------------- ---- ----+----- ----r----- ------ ------------- ---- ----�---- --------- ----- <br /> Water Closet Sewer Ejector <br /> ---- ---- ---•----- --------- ----- <br /> Lavatory Laundry Tray <br /> ----- ---- ---•----- --------- ----- <br /> Bathtub Washer <br /> ------------- ----- ------- ------- ------ ------------- ---- ---^---- --------- ----- <br /> Shower Water Heater <br /> -------- ---- ---•----- --------- ----- <br /> Ritchen Sink ' <br /> I / -_-_-_ Water Softner <br /> -------------+----- --•----- -------- -------- <br /> � ----- ---- ---�----- --------- ----- <br /> Disposal Wet Bar <br /> ------------- ----- ------ ------- ------ ------------- ---- ---•---- ---------- ----- <br /> Dishwasher � Sump Pump <br /> ------------- ----- ----•--- --------- ------ ------------- ---- ------- ------ -- �-..C������ <br /> Sillcocks / Misc. (List) � w� <br /> ------- ---- ---—--- ---------- ----- <br /> Floor Drains � <br /> ------------- ----- ---�---- --------- ------ ------------- ---- --------- ---------- ----- <br /> ******************************************,t******************************** __ <br /> l. Fixture Fee The minimum permit fee is $30.00 $ <br /> Compute number of fixtures x $8/fixture <br /> x $5/fixture reset <br /> 2. State Surcharge $ .50 <br /> 3. Postage � Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PBRMIT 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 an -�co <br /> Signature of A�plicant: Ll- Date: ��/'�-��� <br />