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10/26/2016 09:05 FAX 9529335049 CULLIGAN MNTRA 1�003 <br /> --� . <br /> �,�,y„��,�,��,,,��'�a,���,,,�s�l'��:��.d.i���� � 8�1�1�'�F�" '"M"�F���vu�'EiL���;���,�• I'*� x�:l�;v�'"�,RI��;; � ;�• �a� <br /> � <br /> „r �• �� W �., <br /> ��.��.�Rr�.i�,. �h�W�.a,., ��',..,� o���� ���,P�� ,; {����a,.r.�a!-�"��°r„� <br /> ..s4��. ��� ��w�.���.:r,,. <br /> FIXTURE BSMT 15T 2ND OTHER �IXTURE SSMT 9$7 ZND 07HER <br /> -�-Yp� Floor Floar TYPE Floor Flaor <br /> Water Closet �loor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tr�y <br /> Shawer Washer <br /> I�C�hen Sink Water Heater <br /> Disposal Water Softener ` <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> �� � �.�. � � -�F���n �.��k,� • �,a�� M� .� <br /> Wn�in�..,+ I A1 W � <br /> 1. CONTRACT PR10E *is 1.25% of contract price with a(Minimum Fee of$50.00) <br /> x _0125 $ <br /> (contract price) (minimum$50.OQ) <br /> 2. S7ATE SURCHARGE <br /> x .0005 $ <br /> (contract price) <br /> 3. POSTAGE & HANDLING (Only on Mail-In Applications) $ 2.00 <br /> 4. 70TAL PERMIT FEE (Add Lines 1-3 Above) � � , a� <br /> '* CONTRACT PRICE vr JOB COST means the actual or estimated doll�r amount charged for the <br /> permitted work including materials, (abor, profit, and other'�ixed costs_ It is the amount to be charged to <br /> the customer far the work done. If any material, equipment, labor or instaliations are furr�ished by the <br /> owner, tenant or any other party, the reasonable market value of such items must be added to the <br /> estimated cost or contract price for permit fee purposes. In the event that there is a dispute on the <br /> amounfi of the job cost, the City may request the submission of a signed copy of the actual contract. <br /> �'�°.�_`�..�� �.��i:� ..� „�u.��� , ���w������ ,N, <br /> � � � :•wi �J i, . 61 �il4w IIL�.��'�".!!.'�.��E,�7!.'�m. _ "9 .�i�w(F"nh.��5'���! � nni7w"�.. <br /> The undersigned hereby applies to the Ci'ty for issuance of a Plumbing I�ermit, agrees to do al!work in <br /> strict accordance with t1-ie ordinances of the City and the regulations of the St�te of Minnesota, and <br /> certifies that all staternents made on this applioativn are complete, true and correct. <br /> Applicant's Signature: Date: � �' oZb'��O <br /> Suilding Official/lnspector: Date: <br /> Pe�a <br />