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CITY OF ORONO APPLICATION FOR PLUMBING PERMIT <br /> Box 66 (1335 So Brown Rd) <br /> Crystal Bay, MN 55323 <br /> General Instructions <br /> Off <br /> 2. Mailed in applications are subject to the postage and hand liwn below. <br /> 1. You may apply for plumbing permits by mail or in person at the C <br /> Permit cards will be sent by return mail the same day the applicat 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. `mus <br /> 6. When any new construction or remodeling is involved, a separate builma pzrmit 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 required. <br /> JOB SITE ADDRESS: 1-170S` V�D/�TIfS(d M <br /> Occupancy Type: X Residential Commercial <br /> OWNER'S NAME: l�WFo/4D Phone No. : <br /> Mailing -Address: l�70 _/WJ_ `IL..ft!o/dB O/P City: <br /> CONTRACTOR'S NAME: ,61�I 4f- Bus. No. : z,- ;7-aC2 <br /> Mailing Address: 403o cc��(�s�A� U-/f_/ City: N(i�u�uFTo�y,�ff Zip: l <br /> Master Plumber' s State License No. : City Cert. No. : <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- <br /> FLOOR OTHER <br /> ----------- --- --------- <br /> _I=====_ -- <br /> Water Closet ISewer Ejector <br /> _ _____________-____ ___._____ __________----- <br /> Lavatory _____ <br /> I Laundry Tray ----__- <br /> _____________ _ <br /> Bathtub ' I Washer <br /> i <br /> -------------------- -------- <br /> Shower -------1-- --- ------IWater Heater-I---= _------ - ----- <br /> --------- ---- ------- --- ---- <br /> Kitchen Sink Water Softnerl x I_ <br /> --------------- <br /> -- ------------- <br /> ;------------- -`-j -----------------I----- <br /> Disoosal I Wet Bar �- <br /> —___ -------- ------ <br /> -------------1-----�---- <br /> _—_____ ______------------- <br /> Dishwasher <br /> 1 Sumo PumA <br /> -------------1---- ' ---- --- -----------,------ ------------- ---- ------- ----------Ir----- <br /> Sillcocks j I Misc. (List) L- <br /> --- --- ---- ---- ----------- --------- ---- ------- ----------.LLL ---- <br /> Floor Drains _ <br /> ------------- ----- --- ---- ---------1------1-------------1----1-------- ----------L----- <br /> 1. Fixture Fee The minimum permit fee is $30.00 $ d <br /> Compute number of fixtures -- x $5/fixture <br /> x $3/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 /> 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 /> 1 <br /> Signature of Applicant: rl�-. Date: l0 � 4 <br />