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J1,°, CITY OF ORONO <br /> Box 66 (1335 So Brown Rd) APPLICATION FOR PLUMBING PERMIT ,2Q4 <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. 24 hour notice <br /> required. <br /> *********************************************************jj *** ** ** ****** <br /> JOB SITE ADDRESS: !'2-C Or CitC �`2/� V C �/ <br /> Occupancy Type:L.00 .47, <br /> ii Residential Commercial <br /> t, <br /> OWNER'S NAME: .Ctf . . r` 1'1 K3nst Phone No. : `f'7�✓- - '- `j' <br /> Mailing Address: City: r7 <br /> CONTRACTOR°S NAME: t1iF l71�/ -0 S.. Bus. No. : 55( - 75 t 2 0 <br /> Mailing Address: t2Z OG z(c.E (`od City: 0, {Q 'Oc C tit(Ai <br /> Master Plumber's State License No. : 75(gS P'fr1 1 City Cer 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 /> Water Closet Laundry Tray <br /> Lavatory Washer <br /> Bathtub Water Heater '� +. .4, . <br /> Shower Water Softner <br /> Kitchen Sink Misc. (list) <br /> Disposal <br /> Dishwas*er <br /> Wet Bar <br /> Sillcocks <br /> Floor Drains <br /> Sump Pump <br /> Sewer Ejector <br /> ******************************** ****************************************** <br /> 1. Fixture Fee The minimum permit fee is $30.00 $ <br /> Compute number of fixtures - 4 " t`-'-this- e <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 ..- • ono for issuance of a Plumbing Permit, <br /> agrees to do all work in strict a o da• e ith the ordinances of the City and the <br /> regulations of the State of Min. -so, : and • rti'f s that all statements made on this <br /> application are complete, tru- o <br /> Signature of Applic - -----_- Date: <br /> f_/...;k12._k_._1 <br />