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O1/18/Z017 ATED 19: 15 F� Ark Kdndgement �OOa/OOa <br /> �a' a.ri.i�' '°�''•!, LL.'•�i+N9�'1Jr�-4�i?li1L� ��';��!%�A��1;v,'� Q 'i. .'I''r•��•",:.r <br /> [f above does not apply;follow guidelines below: <br /> 1. CONTRACT PR10E 'is L.25%of contract price with a(Minlmum�ee of SS0.00) <br /> `-��0 o x.oizs a_ _ �( .'�- -� <br /> (conlnct pricc) (ml�loum SS0.00) <br /> 2. STATE SURCHARGE ��J�� O� <br /> � �� x.0005 $ <br /> (wntmct pricc) <br /> 3. POSTAGE&HANDLING(Only an Mail-In Applications) $ 2 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) S � J- �� <br /> • * CONTRACT PRICE or JOB COST meens ehe actuel or estimatod dollar amount charged for the <br /> permitted work including materials,labor,profit,and other fixed costs. It is the amount to be charged <br /> to thc cusEomcr for the work done. If any material,equipment,labor or installations�re fumished by <br /> the ownet,tenant or any other perty,the reasonable msrket value af such itema must be added to the <br /> es[imated cost or contrect price for permit feo purposes. In thc evcnt Ihat th�is a dispute on the <br /> amount of che job cost,the City may roquest tbe submission of a eigned copy of the actual contract. <br /> .. ,,� � ,,R�, ;,�L•L��G��� ''�P�T�Y�A'I'�OI�T,��1t�3 � <br /> The unde�signed hereby applies to tha City for issuance of a Plumbing Permit, agrees to do all <br /> work in strict accordanee witii the ordinances of the City and tht regulatior�s o�'the Stats of <br /> Minnesota, end eenifies that all statements made on this appl�cativn a� complete, true and <br /> oarrect. <br /> Applicant's Signature: Datc: � � <br /> 3 <br />