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11/15/2017 11:45 FAX 9529335049 CULLIGAN 3iNTRA f�003
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<br /> FIXTURE BSMT 1sr ZNp OTHER FITMPEE BSMT Floor Floor OTHER
<br /> NpE Floor Floor
<br /> Water C(oset Ffoor Drains
<br /> Lavatory Sewer Ejector
<br /> Bathtub Laundry Tray
<br /> Shower Washer
<br /> Kitchen Sink Water Heater �
<br /> Disposal Water Softener �
<br /> Dishwasher Wet Bar
<br /> Silicocks Miscellaneous
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<br /> 1. CONTRACT PRICE *is 1.25°/a of contract price with a (Minimum Fee of$50.00)
<br /> .500 •0� x.0125 $ �� � a�
<br /> (contract price) (minimum$50.00)
<br /> 2. STA7E SURCHARGE
<br /> x .0005 $ ' �
<br /> (contract price)
<br /> 3. POSTAGE �HANDLiNG (Only on Maii-ln Applications) $ 2.00
<br /> 4. 70TAL PERMIT FEE (Add Lines 1-3 Above} $ `5�� �` S
<br /> * CONTRACT PRICE or JOB COST means the actual or estimated do(lar amount charged for the
<br /> permitted work including materials, labor, profit, and other fixed costs. 1t is the amount to be charged to
<br /> the customer for.the work done. {f any rnaterial, equipment, iabor or installations are fumished by the
<br /> owner, tenant or any other party, the reasonable market value o� such items must be added to tF�e
<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.
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<br /> The undersigned hereby appiies 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 Stafe of Minnesota, and
<br /> certifies that al{ statements made on this application are complete,true and correct.
<br /> Applicant's Signature: Date: _ 1�- I -��
<br /> Building Officiai/Inspector: Date:
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