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�� X /17 <br /> !' � <br /> 7l� 7l� <br />�s � CiTY OF ORCNO c�PPLIC�TION FOR PLIIMBIiVG PERMIT <br /> Box 66 (1335 So Brown Rd) <br /> Crystal Bay, MN 55323 <br /> *************************************************************************** <br /> ;� <br /> General Znstrnctions � <br /> 1. You may apply for plumbing permits by mail or in person at the City of��ices. <br /> 2, Mailed in applications are subject to the postage and handling fees shown below. <br /> Pezmit cards will be sent by return mail the same day the application is received. <br /> 3. Permits are not valid until yon receive a permit card. <br /> 4. Work must not begin unless the permit card is available on the job�t�;te. <br /> 5. Plumbing permits may be issued to licensed contractors only. "4' <br /> 6. When any new construction or remodeling is involved, a separate build�g permit must � ; <br /> be obtained. C� <br /> 7. All work must be done in accordance with State Code requirements. �T <br /> , 8. All work must be inspected before it is covered. Call 473-7357. 9i�� t <br /> 24 honr notice reqnired. <br /> *************************************************************************** <br /> JOB SITE ADDRESS: �{�-S^ Fo�i 1 S T L+AiC.� 4�Q <br /> -- . Occupancy Type: ,/ Residential Commercial <br /> �:�1NEP`� NP�: /���D �/o u N� Phone No. : �7a� - � � 7.S <br /> Mailing Address: �i I ,tV"� Fo /�F_ �7" `�K� Or4 City: p �s!'� <br /> CONTRACTOR'S NAME: G Lt H</ 6-'� � �.� Q' Bus. No. : �/3�1• 7 0�00 <br /> Mailing Address: � v �o G Gc ��/ G�-�✓ r.fi�A-� City: M l"iC'�4- Z1F= SJ'��� <br /> M a s t e r Plumber' s State License No. : City Cert. No. : <br /> .. ************************************************************��������������� <br /> PLIIMBING FIXTIIRE SCHEDUI,� <br />. � (Show number of fixtures of each tyFe on each floor) <br /> _ FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER FIXTURE TYPE BSMT 1ST FLOOR 2ND FLOOR OTHER . <br /> ---�----- ------ ------------- -- --_�---- --- <br /> ------------- --- T----- -- <br /> �------ r--- <br /> - � �_ �------ Sewer Ejectorl-- j---- �-- <br /> S:ater Closet � � <br /> -------y ----' --- ' --—--- I --------1------ Laundry Tray j---- -- ----i---------�----- <br /> Lavator ' <br /> � � <br /> _.. -------- I --- ---•----- ---------=-- <br /> -------------�- — i <br /> I <br />- � <br /> Bathtub i � I Washer � <br /> ' -------------y-------------y-- ---1------ -------------�---- -------- ---------r----- <br /> Shower � ! Water fieater � <br /> ,... : i ' ------------ ------ -------------�---- ---•----- ---------I----- <br /> -------- ---•— <br /> ----- <br /> _.�, Ritchen Sink ; � Water Softnerj <br /> _____ _____ ____________�_x1________ _________i _____ <br /> cis osal ---�---------------- - - <br /> i ' <br /> Wet Bar � ' <br /> ---P---------1----- ----- ------ ------ ------------- ---- ---.--- ---------�----- <br /> � I� � Sump Pump <br /> Dishwasher I i I <br /> -------------1-----i---- ---j--------- ------ Misc. (List)-�---- ------- ---------- ----� <br /> _ Siiicocks <br /> ------ ------------- ------- - - ----- <br /> ---- ---•--- -------- ----- - -- <br /> , Floor Drains <br /> --------- ----- ---�---- --------- ------ ------------ <br /> *************************************************************************** <br /> 1. Fixture Fee The minimum Fermit fee is $30.00 $ 30 • �' � <br /> Compute number of fixtures x $5/fixture <br /> � x $3/fixture reset <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) $ 3 �'0� � 'F <br /> t <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 j` <br /> , <br /> regulations of the State of Minnesota, and certifies that all statements made on this ;; <br /> application are complete, true and correct. �� <br /> ' i' <br /> �: <br /> � , �� <br /> ... - ! Date: / ""(2 �`l/ <br /> Signature of Applicant:�` ��` <br /> il <br />