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08/19;2013 14:18 FAX 9529335049 CULLIGAN MNTKA [�004 <br /> , 11 .....k.,...:�_w•. ,.:_ •;�y.,�:•,�• ''+� <br /> .. ���., .,..:.....+� <br /> ,..r,rr'- �i�,., nSi��:�.' R ' �� ^!' <br /> t� <br /> �::.';....�:�-:.�:.::..........�" ".. � ' _ <br /> .�... �y <br /> � <br /> . <br /> . � . <br /> ..� . <br /> "v" <br /> . ,.. .. ��� <br /> . ... <br /> ..'\��.`1:� �• <br /> 4! <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimnm Fee of 550.00) <br /> x,0125$ <br /> {wntract prica) (minimum ESO.OU) <br /> 2, STATE SURCHARGE '`*Add the State Bldg Code Div.Surcharge(Minimum Fee of SS.00) <br /> x.0005 $ <br /> (conuacc price) (minimum S 5.00) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2,00 <br /> 4. TOTAI,PERMIT F'EE(Add Lines 1-3 Above) $ �'�U <br /> ■ * CONTRACT PRICE or JOB COST means the actual or estimated doUar amount cfiarged for the <br /> permitted work including materiafs,labor,proflt,and other t"ixed costs. it is the amount to be charged <br /> to the customer for the work done. If any material,equipment, labor or installations are furnished by <br /> the owner,tenant or any other parry,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 /> ■ **The STATE SURCHARGE is.0005 of the contract price under$1,000,OQ0 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 /> ��;µ:, �., c. � `6 '� .e(r.� � �.:a.1 <br /> The undersigned hereby applies to the City for issuance of a Plumbing Permit, 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 appiication are complete, true and <br /> correct. <br /> Applicant's Signature: �J Date: �' 1� - �� <br /> t; ��� <br /> :<?��, .f., ".I.�i�!�4;: <br /> 3 <br />