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Y <br /> j � ' PLUMBING FIXTURES BEING INSTAL.LED <br /> �; <br /> FIXTURE BSMT 1sT 2ND OTHER FIXTURE BSMT 1sT 2ND OTHER <br /> TYPE Floor Floor TYPE Floor Floor <br /> Water Closet � � Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub 3 Laundry Tray 1 <br /> Shower Washer ,'� ,Z <br /> Kitchen Sink + Water Heater �• � <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous � <br /> � <br /> PERMIT FEE CA�CULATION �: <br /> 1. CONTRACT PRICE * is 1.25% of contract price with a (Minimum Fee of$50.00) <br /> �s. � y S � <br /> x .0125 $�,3 � <br /> (contract price) (minimum $50.00) <br /> 2. STATE SURCHARGE <br /> ti r I � 'T � <br /> �,S 7�� X .0005 � 1 <br /> (contract price) <br /> 3. POSTAGE � HANDLING (Only on Mail-In Applications) $ . 0, <br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ --���� �� <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. It is the amount to be charged to <br /> the customer for the work done. If any material, equipment, labor or installations are furnished 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 permit fee purposes. In the event that there is a dispute on the <br /> amount of the job cost, the City may request the submission of a signed copy of the actual contract. <br /> ��'�� � ������� PLUMBING PERMIT APPLICATION A�REEMENT <br /> The undersigned hereby applies to the City for issuance of 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 /> certifies that all statements made on this application are complete, true and correct. <br /> Applicant's Signature: Date: �� ����� <br /> Buildin Official/ Ins ector� �t�%''`�� Date: � l T � <br /> 9 p <br /> Page 2 <br />