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� <br /> � CITY OF ORONO 11PPLICATION FOR PLOMBING PERMIT <br /> • Box 66 (1335 So Brown Rd) �'�jC�� <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 pernit must <br /> be obtained. <br /> 7. All work must be done in accordance with State Code requirements. <br /> 8. Al1 work must be inspected before it is covered. Call 473-7357. <br /> 24 hour notice required. <br /> *************************************************************************** <br /> JOB SITE ADDRESS: j!%' �C JU;� S� 0;`�' A' � 4^� <br /> Occupancy Type: _�_Residential Commercial <br /> OWNER'S NAME: /M(' ` �yii Phone No. : <br /> Mailing Address: �c;,�;� City: (�.��:>c <br /> A � <br /> CONTRACTOR'S NAME: (\ '� t�f r�r��t�e�✓ [;r��� S c�� S Bu s. No. : y�_S- �G� <br /> Mailing Address: Zc`" it,'� �����5� City: (�l�,z�,f� Zip: Ss-3� <br /> Master Plumber's State License No. : �7/2�^� 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 /> ------------- ---- ----a----- ---T----- ------ ------------- ---- ----�---- --------- ----- . <br /> P7ater Closet 7 �- Sewer E ector <br /> ------------ �-- --—--- --- --- ---- ------�---- -- --�---- ------- ---- <br /> - - - - - - - - - - - - - - - - <br /> Lavatory 3 Laundry Tray <br /> Bathtub i Washer <br /> ------------ ----�------- ------ ----- ------------- --- ------- --------- ----- <br /> Shower � ___-_- Water fieater ° <br /> ------------ -�---�--•---- -------- ------------- ---- ---•----- --------- ----- <br /> Ritchen Sink 'I '� � Water Softner <br /> -------------1�-�--•---- ------ ---- ----------- --- -------- --------- ---- <br /> Disposal I_ Wet Bar ' <br /> -------------1 --- ---- ----- ---- ----------- -- --�---- -------- ----- <br /> Dishwasher �- Sum Pum <br /> ------------ --- ------ ------ ---- --p----p--- -- ------ ---------- ----- <br /> Sillcocks -_---_ Misc. (List) � <br /> Floor Drains_ f__- - i_ <br /> ------------ -L -- --- --------- ------ ------------- ---- ---�---- ---------- ----- <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 applicat.ions) $ 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 Dfinnesota, and certi.fies that all statements made on this <br /> application are complete, true and correct. <br /> �� �/,� � �. _ T -Z� <br /> Signature of A�;plicant: ��1J ����' Date: � � � <br />