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09/21/2011 14:15 FA% 9529335049 CULLIGAN ffiNTRA C�004 <br /> • � . <br /> ' - � <br /> ��� �''� ::p��'� .C:A►�C��',�'I��l:'�•':�=JO S�'�'.�!�R•:��OO:Di�;.,;�.,:y' <br /> If above does not apply;follow guidolines below: <br /> 1. CONTRACT PRICE *is 1.25�0 of contract price with a(Minimum Fce of SS0.00) <br /> x.0125 S <br /> (contract price) (minimum S5o.00) <br /> 2. STATE SURCHARGE *'`Add ihe State Bldg Code Div.Surcharge(Minimum Eee of 55.00) <br /> x.0005 $ <br /> (contrect price) (minimum$ 5.00) <br /> 3. POSTAGE&HANDLING(Oniy on Mail-In Appiications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lincs l-3 Above) $ �a•0 v <br /> ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work inciuding materials, labor,profit,and other fixed costs. It is the amount to be charged <br /> to the customer for the work done. If any material, equipment, Iabor or instaUations ate fumished by <br /> the owner,tenant or sny other party,the reasonable market valuc 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 /> amount of the job cost,the City may mquest the submission of e signed copy of the actual contract. <br /> ■ **The STA7'E SURCHARGE is.0005 of the contract price under 51,000,000 or$5.00—whichever is <br /> greater. For valuations over$1,000,000 call the Building Department at(952)249-4600 for the price. <br /> s <br /> The undersigned hereby applies to tha City for issuance of a Plumbing Pertnit, 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: l- �� " �� <br /> � i � '� <br /> 3 <br />