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02/21/2017 09:52 FAX 9529335049 CULLIGAN MNTRA f�003/003
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<br /> FIXTURE BSM7 �sr 2ND OTHER FITMPE E BSMT ��oor Floor OTHER
<br /> -�ypE Floor Floor
<br /> Water Cioset Fioor Drains
<br /> Lavatory Sewer Ejector
<br /> Bathtub Laundry Tray
<br /> Shower Washer
<br /> Kitchen Sink Water Heater
<br /> pisposal Water Softener
<br /> Dishwasher Wet Bar
<br /> Sillcocks Miscellarieous
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<br /> 1. CON7RACT PRICE *is 1.25% of contract price with a{Mlnimum Fea of$50.00)
<br /> � Lj� x .0125 $ � •��
<br /> (contract price) (minimum $50.00)
<br /> 2. STATE SURCHARGE
<br /> x .0005 $
<br /> (contract price) -
<br /> 3. POSYAGE� HANDLlNG (Only on Mail-[n Applications) $ 2.a0
<br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) S �� � a�--
<br /> ; CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the
<br /> permitted work including materials, labor, profit, and other fixed costs. lt is the amount to be charged to
<br /> the customer for the work done. lf any material, equipment, labor or instal{ations are fumished 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 pem�►it fee purposes. In.the event that there is a dispute on the
<br /> amount of the job cost, the City may request the sufamission of a signed copy of tf�e actual contract.
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<br /> The undersigned hereby app{ies to the City for issuance af a Plumbing Permit, agrees to do all work in
<br /> strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and
<br /> certifes that all statements made on this application are complete, true and correct.
<br /> ApplicanYs Signature: Date: a"'�d " ��
<br /> Building OfficiaU Inspector: Date:
<br /> Paye a
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