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. L <br /> . � , , <br /> a. . , , <br /> �=t . . , '.::. , ... , .. ��.�_�- - . <br /> FIXTURE BSMT 1sT 2ND OTHER FIXTURE BSMT 1sT 2ND OTHER <br /> TYPE Floor Floor TYPE Floor Floor <br /> Water Closet �-- Floor Drains <br /> Lavatory oZ-- Sewer Ejector <br /> Bathtub J Laundry Tray r <br /> Shower j Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> < <br /> __;� � -._. . . � . _. . _ . ._ .�,. . - <br /> � � :-. . , <br /> 1. CONTRACT PRICE '' is 1.25% of contract price with a (Minimum Fee of $50.00) <br /> � �. 00d x .0125 $ � 3 I � So//� <br /> (contract price) (minimum $50.00) <br /> 2. STATE SURCHARGE <br /> � <br /> X .000s $ �� ` S <br /> (contract price) <br /> 3. POSTAGE & HANDLING (Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work including materials, labor, profit, and other fixed costs. It is the amount to be charged to <br /> the customer for the work done. If any material, equipment, labor or installations are furnished 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 /> amount of the job cost, the City may request the submission of a signed copy of the actual contract. <br /> Y:� '� �1� � .���T �_�., <br /> .�..r:: .. 1�1�.. __ .: *��.. ._: ; <br /> The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all work in <br /> strict accordance with t inances o City and the re ulations of the State of Minnesota, and <br /> certifies that all statem nts ma e on thi app'cation are c te, true and correct. <br /> Applicant's Signature: Date: � � � �O <br /> Building Official/ Inspector: Date: <br /> Page 2 <br />