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09/20/2011 14:10 FA% 9529335049 CULLIGAN �1VTRA f�004 <br /> . . r <br /> • �. <br /> r. �. ;�: ..,'.p �•'P�:�����T.�`. ��1�$S• ��IZ,�'SU�:� .;:.:� ;� <br /> If above does not apply;follow guidelines below: <br /> l. CONTRAG'T PRiCE * is 1,25%of contract pticc with a(Minimum Fee oi 550.00) <br /> x.O125$ <br /> (canuact price) (minimum�50.00) <br /> 2. STATE SURCBARGE **Add the 5tate Bidg Code Div.Surohatge(Minimum Fee of SS.00) <br /> x.0005 $ <br /> (convacc pnce) (minimum S s.00) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) S c�a�•�v <br /> ■ �' C01V7'RACT PRICE or JOB COST means the actual or estimated dollar amount charged fot the <br /> permitted work includin�materials, tabor,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 ovmer,tenant or arry other paRy,the reagonable market value of such items must be added to the <br /> estimated cost or contract price for permit fee purposes. In tha event thet thore is a dispute on tha <br /> amount of the job cost,the City mey request the submission of a signed copy of the actual contract. <br /> • **The STATE SURCHARGE is.0005 of the contcact price under S1,000,000 or 55.00—whichever is <br /> greater. For valuations over$1,000,000 call the Building Depariment at(952)249-4600 for tbe price. <br /> The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all <br /> work in sfict accordance with tha ordinanees 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 ' � - �� <br /> . � � <br /> 3 <br />