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08/O1/2012 12:37 FA% 9529335049 CULLIGAN �NTRA f�004 <br /> , , � <br /> /� �j ! i ? ` � ' �l�.i'.''.�',tl. <br /> �. .r v ... r, — ,i �Q •p:a• �S•:� �y.k':a..��i <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRAGT PRICE *is 1.25�0 of contraet price with a(Minimum Feo ot SS0.00) <br /> x.0125 S <br /> (conuact prico) (minimum 550.00) <br /> 2. STATE 3URC�ARGE #*Add the State Bldg Code Div,Surcharge(Minimum Fee of S5.00) <br /> x.0005 S <br /> (contract price) (minimum S 5.00) <br /> 3. POSTAGE&HANDLiNG(Onty on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ o�o� .O� <br /> _ .. .. , . _ _ _ <br /> ' ■ '+ COIV7'RACT PRICE or ]OB COST means the actuel or estimsted dopar amount charged for the <br /> permitted work including materials,labor,profrt,and other fixed costs. 1t is the amount to be chazged <br /> to the customer for the work done, lf sny material, equipment�labor or installations are fumiahed by <br /> the owner,tenant or any other perty,the roasonabte market valuc of such items must be added to the <br /> . estimated cost or contract price for permit fee purposes. Jn the event thet thero is a disputo on the <br /> amount of the job cost,the City rnay raquest tt�e submission of a signed copy o�the actual contract, <br /> • *"The STATE SUttCHARGE is.0005 of the contract price under S1,OOO,U00 or$5.00--whichever is <br /> greater. For valuations ova S 1,000,000 call the Building Departrnent at(952)249-4600 for t�e 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: �' �' �� <br /> T- <br /> � <br /> 3 <br />