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May 05 2014 3: 26PM HP LRSERJET FRX p. 9 <br /> . � <br /> I <br /> i <br /> If above dces not Eollow �delines below: � <br /> aPP1Y� Bu <br /> 1. CONTRACT PRICE "is l.25%of contract price with a(Minirnum Fee olSS0.00) i <br /> _ (P.�� � x A I25$ .� <br /> (contract price) (u�iei�rum S�O.UO) <br /> 2. STATE 3URCHARGE ��}r.� X.0005 $ a •�l <br /> sv I <br /> (connacc prico) "�— <br /> 3. POSTAGE&HANDLINCi(Only on Mail-In Applications) $ 2,pp I <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) � �iw,�a � <br /> ■ * CONTRACT PRICB or JOB COST m@ans the actual or estimaUed dollar amount charged for e <br /> permitted work including mata�ials, labor,pmfit,and other fixed costs. It is the amount to be charg <br /> W the customer for the work dane. If any material, equipment, labor or installations are fumished y <br /> the owner,tenant or any other paRy,the reasonable market value of such itecns must be added to 0 <br /> estimated cost or contract price for permit fee purposes. In ti�e event diat there is a dispute an e <br /> amouni of the job cost, the City may reqaest the submissian of a signed copy of the actual con . <br /> � <br /> The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do ll <br /> work in strict accordance with the ardinances of the City and the regulations of the State f <br /> Minnesata, and certifies that all statements made on this application are complzte, true d <br /> correct. <br /> I <br /> Applicant's Signature: Date: ���`� I <br /> i <br /> I <br /> � <br /> I <br /> I <br /> i <br /> � <br /> � <br /> � <br /> I <br /> i <br /> I <br /> 3 I <br /> i <br /> i <br /> I <br /> I <br />