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09/29/2011 10:47 FA% 9529335049 CULLIGAN MNTRA [�004 <br /> , <br /> , <br /> �: _ .:r �;�A��.'...�'��U�Tl�1;TE(.(��J. ''�-��Jf}8.���C��R•.$��Q:Un- .. .. <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE '� is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> x.0125 S <br /> (contract price) (minimum 550.00) <br /> 2. STATE SURCHARGE *•Add the State Bldg Code Div.5urcharge(Mlnimum Fee otSS.00) <br /> x.0005 S <br /> (contrect price) (minimum S 5,00) <br /> 3. POSTAGE&HANDI.ING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT I�EE(Add Lines 1-3 Above) $ aa•Vu <br /> ■ * CONTRACT PRICE or ]OB COST means the actual or estimated doller amount charged for the <br /> permitted work including materials,labor,profit,and other flxed costs. It is thc amount to be charged <br /> to the customer for the work done. If any material, equipment, Iabor or installations are fi�rnished by <br /> the owner,tenant or any other party,the roasonable market value of such items must bc added to thc <br /> , estimated cost or contrsct price for permit fee purposes. In the event that there is a dispute on the <br /> amount of the job cost,the City may �equest 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 call the Building Department at(952)249-4600 for the price. <br /> The undersigned hereby applies 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 /> Applicant's Signature: Date: 9-aq • �� <br /> , <br /> . � . . <br /> 3 <br />