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. <br /> ' _' ' 1 . ' ��. �:i. <br /> • - - 'iwi s' '�_ <br /> � <br /> FIKTURE BSMT 1sT 2ND QTHER FIXTURE BSMT �sT zND pTHER <br /> TYPE Floor Floor TYPE Ffoor Floor <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink �, Water Heater <br /> Disposal Water$oftener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> == " ,,.�" .� yi:.a'.'�i:���.:� ,','"d - � <br /> 1. GONTRACT PRICE * is 1.25% of contract price with a (Minimum Fee of 550.00) <br /> �d�, � x_Q125 $ ��i d� <br /> � (contract price) (minimum $50.00) <br /> 2. STATE SURCHARGE <br /> Gv' � x .0005 $ ' y� <br /> (contract price) <br /> 3. POSTAGE 8� HANDLING (Only on Mail-In Applications) $ 2,00 <br /> 4. TOTAL PERNEIT 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 ta be chargsd to <br /> the customer for the work done. If any material, equipment, labor or installations are furnished by the <br /> nwner, tenant or any other party, the rsasonable market value of such items must be added to the <br /> estimated cost or contract price for permit fee purposes. I� the event that there is a dispute on the <br /> 8mount of the job cost, the City may request the submission of a signsd copy of the actual contract. <br /> _ - -•:���. :�x- <br /> The undersigned hereby applies to the City fot issuance of a Plumbing Permit, agrees to do all work in <br /> strict accorda�ce with the ordinances of the City and the regulations of the State of Minnesota, and <br /> certifies that all statements made on this application ar complete, true and coRect_ <br /> Applicant's Signatur . ` Date: J <br /> Ruilding Official/ Inspector: Date: <br /> Page 2 <br /> Z,Z:a6pd 9Z9b6bZZS6i�ol ZbZTSZZOZ� H'8d uos����puaH weg:wo.a� ZZ:�Z 9TaZ-0Z-Ndf <br />