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— <br /> Fob-20-2007 11:30am From-CITY OF OR0�10 +9522494616 T-308 P.004/004 P-25� <br /> �, ' , i:;:k:r ' �.jif�' ��t ��j� ����,/'► �!��y��•� ••,r �J'p�� n ,�1 , <br /> • ,i.�:.h��.'4 ,.ii����'..���'+�'"+-1 t'�•a' �..t ,�L4Y r,�l • '�rr'r�:.'�� t/��yi� '.e. •.�•''l;��:C' <br /> 4� •ra <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. <br /> :��•;�,t�:. „�,..�����;�,;.,•,, ,;: .:�?��;�E�'L�CA: .,.,. . ,.., . <br /> .,p •.;;�. <br /> .:,�� �. ,��: ,,.,_ :,..,�;. ., <br /> •".��r.."��.n'�• •���i.' ':.� <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 <br />