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� <br /> , 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 s}iown 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 remodelinq 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: �' oj `. `;� ��' .y;�_, ���;; ��f: <br /> Occupancy Type: �' _Residential Commercial <br /> OWNER'S NAME: �� /v�,,;�i�,,,�%r.,�,l Phone No. : y7.3 --,�G. �f�. <br /> Mailing Address: .� � � ,i/�,��;; -�t -� �-t, City: _,,,� � A <br /> CONTRACTOR'S NAME: � t�, I�r)P�()� I� � , 'd- ��r�..l�'C- Bus. No. : �,/%� ".5 ✓����'1 <br /> Mailing Address: y/C���-�.��c,f� /.� /.� ,��.�. �.� City: '7.c �T Zip:,�"j�yy/ <br /> Master Plumber's State L cense No. : �(���'�� � City C rt. No. : <br /> ****,t*******************************�************************************** <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 /> ____________� _ �__-I_ _� ___T_____ ______ _____________ ____ ____�..___ _________ _�___ . <br /> �_� __ <br /> ` Water Closet ) _--__ Sewer Ejector <br /> Lavatory Laundry Tray <br /> _____________ __ y__ ___—____ __'___ ____'________ ____ ___'-.____ _________ _____ <br /> Bathtub 'J Washer <br /> ------------- -�--- -- ------- ------ ------------- ---- ---^--- --------- ---- <br /> ---- , - - - - <br /> Shower � -_--_ Water fleater. <br /> -------------���---•----- --—---- - ------------- ---- ---•----- --------- ----- <br /> Ritchen Sink '` -_---_ Water Softner <br /> --------------+-----�--•----- -------- <br /> ------------- ---- ---�----- --------- ----- <br /> Disposal I_ -_--- Wet IIar <br /> -------------1 --- ---- ----- ---------- -- --•---- -------- ---- <br /> Dishwasher --�- Sum Pum <br /> ----------- --- ------ ------ ---- --p----p--- -- ------ -------- ---- <br /> - - - - - - - - - - - - - - - <br /> Sillcocks Misc. (List) "� <br /> Floor Drains <br /> ***********************it****************************************it********** _ <br /> l. Fixture Fee The minimum �,ermit 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 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 certif3.es that all statements made on this <br /> application are complete, true and correct. <br /> � ,. <br /> �i �,/ <br /> Signature of A�plicant: �� ' � f�-�����'��� Date: / ,3'— � � <br />