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03/15/2018 TxU 1G: 36 FAx 763 473 8565 S�bre xedting & Air Cond �003/006 <br /> FIX7URE 6SMT 1�T 2 ° OTHER FIXTURE BSMT 1sr 2"o OTHER <br /> TYPE Floor Floor TYPE Floor Floor <br /> Weter Closet Floor Drains 1 <br /> Lavatory � Sewer EJector <br /> 6athtub •� Laundry Tray <br /> Shower � Washer ( <br /> Kitchen Sink 1 Water Heater <br /> Disposal � Watar Softener <br /> Dishu►asher � Wet Ber <br /> Slllcocks � Miscellan�ous � <br /> 1. CON7RAC'f PRICE * Is 9.25% of contrdct pripe with a(Mlnlmum Fee of�50.00) <br /> �Aoo10 i x.o�2s $ Z3']. 5� <br /> (contract price) (minlmum�50.00) <br /> 2. STATE SUI�CHARGE <br /> �Ar��.n� X.000S $_.. , q��+ <br /> (contract price) <br /> 3. POSTAGE� HANpI�ING(Only on Mail-In Appiications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) � �q•I O � <br /> " CONTRACT PRICE or JOB COST me�ns the actual or estimated dollar amvunt charged For the <br /> permitted work incluciing materials, I�hor, profit, and other�xed cvsts. It is the amou�t to be charged to <br /> the customer for the work done, If any material, equipment, labor or installatio�s are fumished by the <br /> owner, tenant or any other party, tl�e reasonable market value of such items must be added to the <br /> estimated cost or contract prlce 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 underslgned hereby applies to the City for issuance oi a Plumbing Permit, agrees to do all worlc in <br /> strlct accordance with the ordinances of the City and the regulations of the State of Minnesota, and <br /> ce�tifies that all statements made on this appllcatlon are complete, true and correct. <br /> Applicant's Slgnature: ,��►.G�l�l/b,r �QU;4�GUyWwL Date: �� 1 F'J' Z0�� <br /> Bullding Officlal/ Inspector: Date: <br /> Pape 2 <br />