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. ._ .� _ ____.. _ . ... . ___ . ______.�_._ .. ._....._:_ <br /> a <br /> Box 66 (1335 Brown Road South) <br /> Crystal Bay, MN 55323 <br /> ****************************************************************** .� <br /> General Information <br /> . ._ _. .� <br /> 1. You may apply for plumbing permits by mail or in person at the City offices. � <br /> 2. Mailed in application are sub ject to the postage and handling fees shown below. Permit Cards wi <br /> be sent by return mail the same day the application is received. � <br /> 3. Pezmits are not valid until you receive a permit card. <br /> q, work muot not begin until the permit card ia posted on the job sito. <br /> 5. Plumbing permits may beissued to state-licensed plumbezs or to homeowner/occupanta who intend � � <br /> pctually perform their own work in their home. t <br /> 6. When any new construction or remodeling is involved, a separate buildinq permit must be obtain <br /> 7. All work must be done in accordance with the State Suilding Code Requirements. � <br /> 8. All work must be inspected before it is covered. Call for inspections 24 hours in advan <br /> (473-7357). <br /> Instructions. Complete all items on this application. Compute the permit fee. Siqn and date <br /> certification. Incomplete applications will not be processed. if you have, any questions, <br /> 473-7357. '' <br /> WALR-IN PERMITS--Apply at City Offices, 1335 Srown Road So. (County Rd 146) <br /> MAIL-IN PERMSTS--Enclose Fee--Mail to: P.O. Box 66, Crystal Bay, MN 55323 <br /> �k�k************�t*�k*it7k*�k**�*********ir*�t***�Ic***�k******�c*�k�k*�k**#***********7ktk�c <br /> JOB SITE ADDRESS ��fJ,� ,f'/}Q/L ,�P.3�,�1:�- <br /> Occupancy Type: +.� Residential Commercial <br /> Work to be Performed by: Licensed Contractor � Owner/Occupant <br /> OWNER'S NAME (��j�-,1��'�'1 ,� r ,S�_�-f�3L L. Telephone No. �7� -��J� <br /> Mailing Address _ („[?c �• ,�-p K ��;� /.cr.►�,;� tt�k.�. f�9�1 c S 3.�� <br /> PLUMBER'S COMPANY N1�ME S �,� �l3 c�� Bu s i ne s s No. <br /> Mailing Address <br /> �' <br /> Master Plumber ' s State License No. City Cert. No. s <br /> **�k****91r***it*�Ir****�k**************it*dk**�Ie**�Ik***********�It�k**�********ir�k�k**ltik*�Ir > <br /> PLIIMBING FIXTIJRB SCHSDQLB <br /> (Show Number of Fixtures of Each Type on Each Floor) <br /> FIXTURE TYPE HSMT. lst Floor 2nd Floor Other Floocs FIXTLIRE TYPE BSDiT, lsi Flooc 2nd Floor Other Floors <br /> water Closet Laundr�Trav <br /> Lavatorv Washer <br /> Bath[ub � Water �leater <br /> Shover _ Water Sofcner � <br /> KitcFen Sink _ Misc. Fixtures: � <br /> Dis�osal (Lis U <br /> D i s'��.•a s.`.e r <br /> Wet Bar <br /> Sillcocks <br /> Floor Drains <br /> Sum Pum _. <br /> Sewer E'ector '"�T.A �UMBER OF FIXTURES <br /> *�t***7k*************7k***********7k***7k*�k****�k***7k*�t"k7kiC**7kir*******!k**7k***7k*** <br /> PERMIT FEE CALCULATION <br /> _ <br /> 1 . Fixture Fee. The minimum permit fee is $25. 00. <br /> Compute number of fixtures x $4/fixture $ �S y" <br /> 2. State Surcharge $ .50 <br /> 3. Postage and Handling (Only for Mail-in applications ) $ 1. 50 <br /> 4. TOTAL Permit Fee (Add lines 1-3 above ) $ � �, O � <br /> ************************************************�************************* <br /> The undersigned hereby applies to the City of Ozono for issuance of n PLUMBING PERMIT, agrees to do all I <br /> work in s ict accordance with the ordinances of the City and the regulations of the Minnesote State ; <br /> euild' ode, nd certi 'e tha a atatements made on thia application are complete, true end <br /> corr `� � �.�C/ /Y� <br /> � j� _��-,� <br /> Signa uze of Appl cant Date <br />