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J <br /> ' _ <br /> ' F'LCi141FB11+�G�i�CTUF�E=S BEtNC I�ST�iL.LED , <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2ND OTHER <br /> 7YPE Floor Floor IYPE Floor Floor <br /> Water Closet Fbor Drains ��`� <br /> Lavatory Sewer Ejecto� <br /> Bathfiub Laundry Tray <br /> Shower Washer <br /> IGtd�en Sink l T�� Water Heater <br /> Disposel Water Softener <br /> Dishwasher Wet Bar <br /> Sillooc:ks Miscellaneous � +-lo� <br /> 1 <br /> " ` t�ERMtT FEE C�CUl�4TIC31�t _ <br /> 1. CONTRAGT PRICE *is 1.25°�of contrad price wi#h a(Minimum Fee of�v0.00� <br /> �� x.0125 $ �D�= <br /> {c�ntract price) (minimum$50.00) <br /> 2. STATE SURCHARGE <br /> 5a <br /> ��� x.0005 $ � � <br /> (contract price) <br /> 3. POSTAGE 8 HANDLING(Oniy 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 estimated doilar 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. Jf any materia{, equipmen#, labor or insta�lations are fumished by the <br /> owner, tenant or any other party, #he reasonable market value of such items must be added to the <br /> estimated cost or contract price #or permit fee purposes. In the event that there is a dispute on the <br /> amount of the job c�ost, the City may request the submission of a signed copy of the actual contract. <br /> PLUMBiNG PEftMIT APl�LiCAT14N A�R�EMEh1T <br /> The undersigned hereby applies to the City fa issuance of a Plumbing Permit, agrees to do all w�ork in <br /> strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and <br /> certifies that all statemen ade�.on this ap lication are cflmplete,true and correct. <br /> ApplicanYs Signature: Date: V� �� ��� <br /> Building OfficiaV Inspector. Date: <br /> Page 2 <br />