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08/19/2013 14:19 FAX 9529335049 CULLIGAN MNTKA �J007 <br /> r':2" �f'.; "�y�{;..y�' �yy��7{�,}F�.,k {���(�.�,��y� \yy �T1 ^/�� ✓�O.V� .'S�.."6, <br /> ,:^�:^:��L••]3/���� �-Y+��" :�i`s.!'•"�^'.�j'�tiW;��i!�:��, ��� ,�. ,+$':' <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE �`is 1.25%of contract price with a(Minimum Fee of SS0.00) <br /> x,0125$ <br /> (contract pnce) (minimum 550.00) <br /> 2. STATE SURCHARGE **Add the State Btdg Code Div,Surcharge(Minimum Fee oi$5.00) <br /> x.00QS $ <br /> t����p��) (minimumS 5.00) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ aa •� <br /> ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work including matcriafs,labor,profit,and other fixed costs. It is the amount to be charged <br /> to the customer for the work done. If any material,equipment, labor or installations are fumished by <br /> the owner,tenant or any other parly,the reasonable market value of such items must be added to the <br /> estimated cost or contract price for permit fee purposes, In the event that there is a dispute on the <br /> amount of the job cost,the City may request the submission of a signed copy of the actual contract. <br /> • **The STATE SURCHARGE is,0005 of the contract price under$1,000,000 or$5.00--whichever is <br /> greater. For valuations over$1,000,000 Cail the Building Department at(952)249-4600 for the price. <br /> s?�N����y <br /> � ,h "�� �"f,�",.. _ �t e dF ::r.R;.^� <br /> kfl� <br /> The undersigned hereby appiies to the City for issuance of a Plumbing Permit, agrees to do all <br /> work in strict accordance with the ordinances.of the City and the regulations of the State of <br /> Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> 's Si nature: U� Date: • � ' � <br /> Applicant g <br /> �; ..,m.s��;: ;.i��,�::: <br /> 3 <br />