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' CITY OF ORONO 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 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 reqnired. <br /> *************************************************************************** <br /> JOB SITE ADDRESS: ��� ��(�TN ��r�Qc:a_. ���v�- • <br /> Occupancy Type: Residential Commercial <br /> OWNER'S NAME: _ _��eT� (Z , E'�«,�sc� Phone No. : _�3- 7DS� <br /> Mailing Address: ____ a�p � r�} � � p��=�`�ity: CL�,��n , <br /> CONTRACTOR'S NAME: I� '�Z�-�'��S . a��', P�l,l1�s`e�`�(�us. No. : �7�--�"zo� <br /> Mailing Address: �t'9c Z��{-D City:�kCct,sc�9�_ Zip: �s3s � <br /> Master Plumber's State License No. : t�-1 '� P►M City Cert. 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 /> ------------- ---- ----�----- ---T----- ------ ------------- --- ----�---- -------- ----- <br /> Water Closet � Sewer Ejector <br /> Lavatory � Laundry Tray <br /> Bathtub Washer <br /> ------------ ----�------- ----- ---- ----------- -- ---^--- ------- ---- <br /> Shower ' Water Heater <br /> Ritchen Sink ' -__-__ Water Softner <br /> � -------------�---- -•---- ------ ----------- -- ------- -------- ---- <br /> Disposal I_ Wet Bar <br /> -------------1 --- ---- ----- ---- ----------- -- --•---- -------- ---- <br /> - - - - - - - - - - - - - - <br /> Dishwasher--_�- -_-_-_ Sump Pump <br /> --------- ---- ----•--- -------- <br /> ----------- ---- ------- ---------- ----- <br /> Sillcocks I Misc. (List) <br /> Floor_Drains-1----- ---�---- -------- ------ ------------- ---- ---�-----�---------- ----- <br /> ************************************************************ ************* <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 b 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 correct. <br /> ��i4 5 T�G /f� � � � <br /> Signature of Applicant: .� `d°��! -� � Date: �� ��� �z-- <br /> i <br />