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C T. CITY OF ORCNO 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 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 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 required. <br /> ****************************************** **** ****** ********************* <br /> JOB SITE ADDRESS: t_-) U L/.2e .>- C ' o�{c t <br /> )V' <br /> - Occupancy Type: Residential Commercial <br /> • <br /> OWNER'S NAME: ge,,,� � j�� :4-Qe Phone No. : <br /> Mailing Address: to (>2erU +•- /?/ City: /9,/.2-o7-4-e,- <br /> CONTRACTOR'S <br /> jj ,7---e'-CONTRACTOR'S NAME: ..; 4-0-04.-4e----.- / 61 Bus. No. : II ?-Z / TT <br /> Mailing Address: 7-7Jc, ( / /( .v City: ,- r Zip: :s3-2,c-<1 <br /> Master Plumber' s State License No. : 'Z,' / /'/`> 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 /> Water Closet I J / I Sewer Ejector --- <br /> -6 — -. --+ <br /> Lavatory I) I / Laundry Tray <br /> Bathtub , Washer <br /> j I i <br /> _ Shower I <br /> Water Heateri r <br /> - Kitchen Sink ' / IWater Softnerj J - <br /> [ <br /> Disposal <br /> 1 I i / --- Wet Bar <br /> I 1- <br /> Dishwasher 1 I -/ - Sump Pump - <br /> Sillcocks i -- ' --- Misc. (List) <br /> Floor Drains 1 <br /> J. <br /> *************************************************************************** <br /> 1. Fixture Fee The minimum permit fee is $30.00 $ <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 /> *************************************************************************** <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 /> Signature of Applicant: <br /> 4 - ( /11_,-,e6"--.-.. Date: `/ ‘ --. (--2/ i <br />