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<br /> Fob-20-2007 11:30am From-CITY OF OR0�10 +9522494616 T-308 P.004/004 P-25�
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<br /> If abovz decs nnt apply;fallow�uidelines below:
<br /> 1. CON�CT pYtYCE +is 1.25°�of comracc pricc with a(Minimum Fee of S3S.b�
<br /> �_S,ODD X.0�25 s �ia, s�
<br /> (contnct pricc) (mi�simum 533.00}
<br /> 2. STATP Si]RCHwRGE *•Add the Stact Bldg Codo Div.Surcluuge(Miuimnm Fee otS.SQ)
<br /> _ �i 5,d0O X.000s s 3�, Sv
<br /> �a'"�P���) (nri�itrnim S SO)
<br /> 3. POSTAGE&FLA,NpI,TIdG(Only on Mai1-�n Applicarions) $
<br /> 4. TOTAL PERMYI'�E(Add�.ines 1-3 Above) � ���(•'SO
<br /> • * CONTRACT pl'�tTCE or 3QB COST nieans the actual or estimatad dol]at amount chas�cd for the
<br /> prrmitted worl:including materials,labor�profi�,and onc�r fixed costs. Yt is the amo�ro be cl�arged
<br /> to thr custcma for the work done. If any mab�rial,equiPm�nt,labor or installauops are fivaished by
<br /> the owner,tanant or any other parry,�e reasonable market valuc of sucb ixms musc be added to the
<br /> cStlIDAt�CCd COSt OT COnhSCi priCC POi FCT1rilT ft2 p11tpOSC4. In the event�tbere is a dispure on the
<br /> amoimc of the job cos; tbe City may rzqucsc rhe submission of a sigasd capy of�actuai contrAcr.
<br /> • *•Tlre STAT'�SURCHARGP is.Q005 of the connact price under$1,OOO,Q00 ar$,SQ—whicbever is
<br /> �reater. For valuatiaus over�1�000,000 cnll�he auiidin�Dcpar�rnt$t(952)249-4600 foi tbe price.
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<br /> 'The uadersigued hrrrby applies w the Ciry for issuance of a Plumbing Pesxnit, agrees to do all
<br /> worlc in strict accordance with �tie ordinances of the GYry and the reg,ilationc of the gtate of
<br /> Minnesota, and certifies that all statement, made on this applieauon are camplete, �ue and
<br /> corteci.
<br /> Applicant's Signature: �!��fU ?�Gr/�
<br /> � Da�: 2 Z3 0
<br /> 3
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