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. � ' � <br /> ,� � . ,, t a � - ' �' �: �4.� � "'"�i��- ,;�„� <br /> ,�:.� s.: ���;���. � ��� �. ;���."�U,M�II�C.:f IX�URE3 E1�1�::lNST`ALL�D.k.;° ;: �� <br /> ,.� f m <br /> FIXTURE BSMT �sr 2ND OTHER FIXTURE BSMT 1sT 2ND OTHER <br /> TYPE Floor Floor TYPE Floor Floor <br /> Water Closet � Floor Drains f <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower t � Washer � <br /> Kitchen Sink � Water Heater ( <br /> Disposal � Water Softener <br /> Dishwasher � Wet Bar <br /> Sillcocks �' Miscellaneous <br /> h�'e',�9s?�'4^ � � � �y` �� rl��+.� ...:�"cf'^"'.. � �.� 'p�'�;�+s '���F&� � .;'�„%A ���"� ,,,,,��?'` <br /> ak.., _ •.. � ..._ ... .... .. <br /> :�S"�.�,.t� . <br /> 1. CONTRACT PRICE * is 1.25% of contract price with a (Minimum Fee of$50.00) <br /> (�_��, x .0125 $ <br /> (contract price) (minimum $50.00) <br /> 2. STATE SURCHARGE <br /> x .0005 $ <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 estirr�ated 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>-�,g'" � �� .� ..7Y:1�- �lah�i"�+,�x c:'�1:t •� ;. " f.y ��*�.�A't z� � �S«�:�,' ,T��k"g, <br /> � �.. �' �.��;'�`.a�r.� ..++i4r`.��' <br /> The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all work in <br /> strict accordance with the ordinanc o the City and the regulations of the State of Minnesota, and <br /> certifies that all statements e on h a plication are complete, true and correct. <br /> Applicant's Signature: Date: 2� ( Z' �� <br /> Building Official/ Inspector: Date: <br /> Page 2 <br />