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05/26/2016 15:a4 FAX 8529335049 CULLIGAN MNTKA f�004 <br /> s�u,�g� s� w �ry'���� y�� �I.a�'� �i�1 �/?�' �.r hv 1'.� r"J:'�4�:-"�;�v;'�; ''',y' <br /> �.r, '�:1 n e �. a i �G'�.C„�;:'�,yrl,�, <br /> �„+'Wyi'�r�:�'t".ii'lr�r, y° ��r� ° 'h�°� �V7:+:J7-��1�1.�� ,;����3'+]��`�%f�p; �''.,����i.l,.. _ <br /> lf above does not 8ppty;follow guidclines below: <br /> 1. CONTXtACT PRICE *is 1.25%of contract price with a(Mlnimnm Fee of$50.00) <br /> x.0125$ <br /> (cpnp'act pricc) (minimum 5�,00) <br /> 2. STATE SURCHARGE *'�Add the State Bldg Code Div.Surcharge(A�iinimum Fcc cf55.00) <br /> x.D005 $ <br /> (conhact prite) (minimum S 5.00} <br /> 3. P05TACy�&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. 7'OTAL PERMTT FE�(Add Lines I-3 Above) $ �r� . a1 S <br /> ■ "` CONTRACT PRICE or 70B COST means thc actual or esrimated dollar amount charged for the <br /> permitted wark including materials, labor,profiY,snd other fixed costs. It is the amount to be charged <br /> to the customer for the work done. If any material, equipment, labor or inscalIations sre fumished by <br /> the owaer,'tenant or any other pany,the reasonable market value of such items must be added to the <br /> estimated cpst or co�act price for permit fcc purposes. In the evcnt eItat there is a disputc on the <br /> amo�u►t of the job eost,the City may request the submission of a signed copy of the actuAl contrac� <br /> ■ **The STATE SURCFIARGE is.0005 of the contraet price unde�r$1,000,000 or$5.00—whichevcr is <br /> grcater. For valuations over S I,000,000 call the Baildin$Department at(952)249-4600 for the price. <br /> hi: r � i�,Jst1��l 1D i T ,�;��"� �qp� i i �r,,,rp�� r J�-x 1�N� <br /> 2.����11�d��f?f1�I�F,�„d.l;��Y1L� ." '�I�i�' ��41G71l�°�,`�i"�' 1 e7�ry�t r�,`�4��, nr��� d�+�t'�:':;�I�� <br /> �Ae�.4 �"-iAM� -`i��� M i � i ��Jy" ��' IRY ��1',`�:L:Y��t�,�a�i�;41tnK;xw ����� M,'.,ii1' <br /> The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do al! <br /> work in strict accordance with the ordinances of the Ciry and the regulations of the State of . <br /> Minncsota, and certifies that a)1 statements made on this applieation are complete, true and <br /> correct <br /> Applicent's Signature: � pate: .S'o�b � ���_ <br /> "M7�(t"S Jnvr'XYlV1i'�j <br /> '�es'7et���or�", <br /> f�:.';Jir;",,,:r.�'Pn:u+J:�Y"Y�a� <br /> 3 <br />