Permits - Permit# 426 - 2452 Black Lake Road - 1/1/1986Q
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CITY OF SPRING PARK
P.-0. BOX 452 APPLICATION FOR PLUMBING
SP*NG PARK, MN 55384 P E R M I T
General Information
1. You may apply for plumbing permits by mail or in person at the City offices.
2. Mailed in application are subject to the postage and handling fees shown below. Permit.Cards will
be sent by return mail the same day the application is received.
3. Permits are not valid until you receive a permit card.
4. work must not begin until the permit card is posted on the job site.
5. Plumbing permits may be issued to state -licensed plumbers or to homeowner/occupants who intend to
actually perform their own work in their home.
6. When any new construction or remodeling is involved, a separate building permit must be obtained.
7. All work must be done in accordance with the State Building Code Requirements.
a. All work must be inspected before it is covered. Call for inspections 24 hours in advance
(473-7357).
Instructions. Complete all items on this application. Compute the permit fee. Sign and date the
certification. Incomplete applications will not be processed. If you have any questions, call.
473-7357. 1
WALK-IN PERMITS --Apply at City office,, 4349 Warren Ave.
MAIL -IN PERMITS --Enclose Fee --Mail to: P. 0. BOX 452, Spring Park, MN 55384
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JOB SITE ADDRESS
Occupancy Type: /` Residential. Commercial
Work to be Performed by: Licensed Contractor Owner/Occupant
n '7�_ t
OWNER'S NAME _
Mailing Address
PLUMBER'S COMPA
Mailing Address
Master Plumber's State License No. City Cert. No.
PLUMBING FIXTURE SCHEDULE
(Show Number of Fixtures of Each Type on Each Floor)
7
FIXTURE TYPE
BSMT.
1st Floor
2nd Floor
Other Floors
FIXTURE TYPE
BSMT.
1st Floor
2nd Floor
Other Floors
Water Closet
Laundry Tray
Lavatory
Washer
Bathtub
Water Heater
Shower
_ _
Water Softner
Kitchen Sink
_
Misc. Fixtures:
Disposal
(List)
Dishwasher
—
Wet Bar
Sillcocks
Floor Drains
2.uMp Pum
ER F FIXTURES
Sewer E ector
PERMIT FEE CALCU
1. Fixture Fee. The minimum permit.fee i $25.00. co
Compute number of fixtures x $4/ >_ $
2. State Surcharge
3. Postage and Handling
4. TOTAL Permit Fee (Add
$ .50
(Only for Mail -in applications) $ 1.50
lines 1-3 above) $
The undersigned hereb ap ii to the City of Orono for issuance of a PLUMBING PERMIT, agrees to do all �I �I
work in stri .accor a e th he ordinances of the City and the regulations of the Minnesota State /
Buildi g C ; n c ti a hat all statements made on this application are complete, true and ] y/
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Si u e App cant Da e
a �, o�
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Form No. 294 0'c:�6-4- j-
Miller -Davin 1"'. Minn.HP0 in
No. -
State of Minnesota, CJ�_of 5PR/A G
( rf.
County of fmA 14 _ �l 1 Office of 0 T( L
aEvzER lw&7E& Permit
IN CONSIDERATION OF The statements made by U-7S 124 Q I S in 8 15 application therefor duly filed in this off , which ap 1.catio 's ereb made a part hereof,
PERMISSION Iti HEFiI':}IY CRANTEI) To : tic _— ----.— as ownerto
upon that tract. of I nd d 'scrih'd as follows: Lot � Block — plat or d iti
Address t 7 —
kv1iich tract is of the size and area specified in said application.
This permitis granted kipon t.lie express conditions that said owner and h-- con tractors, agents, workers
and employees. *call comply in 11 respects with the ordin n c .s of the
Given under Hit, hand of the _- Jul- _ .__-�151�1-L.__of said.- and its Torpor
seal and attested by its.__.�rn� _—_-- th s___��—__da,y of— ALZ6j�j_ 19
Attest ,