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<br /> Tf above does not apply;follow guidelines below:
<br /> 1, COIVTYLA p1t10E * is 1.25%of conCr&ct price with a(Minimum�'ee of$50.00)
<br /> ����/� �� x.0125$ �/�7���
<br /> (tOnlratt pCiCe) (mioimum S5fl.40)
<br /> 2. STAT�SURCHARGE ��y�
<br /> (�� � �� x.0005 $ ��
<br /> (contrBCt pr{CC)
<br /> 3. pOSTAGL&1-CANDLING(Only on Msit-Tn Applicaiions) $ 2.00
<br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ���f" —
<br /> ■ * CONTRAGT PR.ICE or JOB COST means the actual or tstim&ted dollar arnount chargtd for the
<br /> permitted work inoluding materials,labor,profit,snd otfter fixed costs. Ct is the 3mount to be charged
<br /> to the customer for the work done, ff any rnaterial,equipment,labor or instsllations are furn•ished by
<br /> the owner,tenant or any other party,the reasonabfe market value of such items must be added to the
<br /> estimated eost or contract price for permit fee purposes. In the eWent that there is a dispute on the
<br /> amount of the job eosC,the CiCy may request the submission of a signed eopy of the actual contraet.
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<br /> ���H a�,:R,t,G�,u -_ .{`; 1�' ..�' _ - ,iV..�,.ii:"'!1:'�_Y
<br /> The undersigned hereby applies to the Ciry for issuance 4f a plumbing Permit, agrees to do all
<br /> work in strict accordanee with the ordinances of ihe C►ty and the regulations of the State of
<br /> Minnesota, and certifies that all st3tements made on this application are complete, true and
<br /> correct_
<br /> � ` �
<br /> � � Date: / �� ��
<br /> Appl�cant s Si�xtu c:
<br /> 3
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