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10/12/2017 THU 1Q: 30 FAx 763 a73 8565 8ebre Hesting & xir Cond �004/007 <br /> I!'ahovc docs not ap��ly;follow�uidelincs below' <br /> � 1. TRACT]'AICE �' ix 1.25°/n of wntraal pria:with a(1Vliuitnu�ti Ncc uf 550.00) <br /> ��0���!•�`I x.U125 $ �t.� <br /> (conlTeCtprim) --•'(minimum�S0.0U) -•� <br /> 2. STATE S�RCY�AkG� <br /> �..��.��:�..,.�.,.�..�.00as ��___._—��b� <br /> � (�eutrncc prux:e> <br /> 3. 1�USTACiE&�ANDLING(Only on Mail-Iu Applications) S 2,Od <br /> a. 'f0'lAL PERMT�'�E(Add T.ines 1-3 Above) � �)�•��-�' <br /> M * CONTRACT p3.uCB or JOB COST mc�ns the actusl or estimated dollar amounc char�ed for the <br /> petxaitted work including nxaterials�labor.proft,and othea•t'ixed costs, It is ihe amoutat to Ue charged <br /> � to the customer for the work done. If any materiai, equipment,Iabor or instellations are fumished by <br /> � the owner,tcnant or any other party,t5e re�sonable market value of such items must be added to tho <br /> , estimatec[cost or contract price for permit fee purposes. In tlie ove�that there is a,dispute on the <br /> , amount of iho job cos� the City may request the 4ubmission of a signed copy of the actual contxaat. <br /> The undo�rsigned hereby applies to the City for issusnce of a Plwnbing Permit, agrees l•o dt� aI1 <br /> work in siriot accordAnce with the ordinanees of flie City and the regulations of tU,e State oi' <br /> Minnesota, and certif"ies that e11 statements made on this ap�lic�lion fu�e coinplete, trve and <br /> cozxect. <br /> Applzcant's Signature: Date: , }0'�2•�/`� .� <br /> , � <br />