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i <br /> - iiITY F ORONO <br /> APPLICATION FO DMB*NG PERMIT <br /> Box 6' (1335 So Brown Rd) <br /> Cryst' 1 Bay, MN 55323 aL: : <br /> ***** ***********1r********************************************************* <br /> Genera Instructions '. <br /> 1. Yo may apply for plumbing permits by mail or in person at the City offices. <br /> 2. Ma led in applications are subject to the postage and handli $,gee hoy�m,�low. <br /> Pe it cards will; be sent by return mail the same. day'the applicAnchiA ce�i d. <br /> 3. Pe is are not laid until you receive a permit card. <br /> 4. Wok must not beg n unless the permit card is available on,the job site. <br /> 5. P1mbing permits Tay be issued to licensed contractors only. <br /> 6. Wh n any new construction or remodeling is involved, a separate building permit must <br /> be btained. <br /> 7. Al work must be done in accordance with State Code requirements. <br /> 8. Al work must be inspected before it is covered. Call 473-7357. <br /> j 24 hour notice required. <br /> ***** ***********^******************************* *********************** <br /> JOB SITE ADMEN: ! ***5(oS Old en-61-at is S. <br /> Occupncy Type: )( Residential Commercial <br /> OWNER S NAME: JOIl6L 1(Ml FiPhone No. : 44148- gl a2.0 <br /> Maili g Address: t yQQ. .-, City: !)rI3Y10 <br /> n <br /> CON ° CTOR'S NAME:! f r/C dv) /"LG �4/(hal/( ' Bus. No. : 422- 6 <br /> Maili g Address: + 4'lQ Its,-' - .Sr- �J City: /`A-7i6L Zip: 5T <br /> Maste . Plumber's State License No.: J/6'5t1 City Cert. No. : <br /> � <br /> - ***** :************1********************************************************* <br /> i 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 /> Water C oset Sewer Ejector ' <br /> Lavator Laundry Tray <br /> r <br /> _ <br /> Bathtub', t Washer I " <br /> Shower Water Heater .._�. <br /> a ---- --p---- r <br /> Kitchen Sink II Water Softner. - I j <br /> Dispose I Wet Bar ' <br /> Dishwas er Sump Pump ', <br /> t. <br /> Sillcoc sem• ------ Misc. (List) -- - <br /> Floor D ains <br /> ***** :********************************************************************* <br /> 1. F xture Fee The minimum permit fee is $30.00 $ , ( <br /> C.1 pute number of fixtures x $5/fixture <br /> x $3/fixture reset <br /> I I - <br /> 2. State Surcharge $ .50 <br /> / 3. Pcstage & Handling (Only mail-in applications) $ 1.50 . <br /> n4. TfTAL PERMIT FEE (add lines 1-3 above) $ 5A,eyo <br /> ******i********************************************************************* <br /> The undersigned hereby applies to the City of Orono for issuance of a Plumbing Permit, <br /> agrees 'i 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 /> Signature of Applicant: /C�/ 1 i:0- S .i (� ?Date: /0-73 ,, ) <br />