|
Jun, 27. 2417 12; 55PM No, 0434 P. 4_
<br /> 0E�< <�� ��i� i�.1J 9522494616 CI1"Y QF OR�IQ rNu� 03/B3
<br /> � �,�{ - ,
<br /> �� ' .�, ,�,.a �;�^ �j �'L'�,. �..a' ��,��,;n� A'�I
<br /> P' '!f! I:','. �f n;'' i a:r:�.. ti_�;<<I
<br /> .r >r tj` ,'�'�..f� ir,,,;; S.a��i
<br /> n � ' r ei�l B i i .1 �:>:i.: r.—_.
<br /> ;;���h' ��: �N.�r.�''y'k.s,�, a�;,.,tr��;;� .1��..��'''���'T�'�
<br /> ,;: ,,
<br /> FIX1"UR� sSMT 1ST 2�' OTHER �'IXTUftE 9SMT 1 T � ��ER
<br /> TYPE FioOr Floar TYPE Floo� Floor
<br /> Water Clo�et Floor Dralns
<br /> �a��ry 9ewer�vctor
<br /> Bathtub Leunciry Tray
<br /> Shower Washer
<br /> Kltehen Slnk Water Heater
<br /> Dlsposal Water Softener
<br /> pishwasher Wet Bar
<br /> Sillcocks MlaceRaneous l►1 � �a � ��k'
<br /> � d�.�J� C�c. b o��r v�.�Q,.�,,����
<br /> ..'. ., L'+'tiJ- j'e,! •i;J}��n din'�B7a,;�u�I�!' \,��'�.l�LX•
<br /> �`k; �•••�+' y � l,�N 3 �74� yl � ,;;;jr_�;;,' �„I;�:.,G.`,J�'1�;�'Y'••:,; L r!'i'.,.
<br /> �t"�!�'f :r '�I, N74,� i^�r 4.I��,IG., _b.��f: i. ,i �',1��..'i,,.,�it:. _r.,.n•',., "!R'�;,..r•,.:;p�..� .i!;•�{•�•:•: ,
<br /> •e,�. _'4;••-
<br /> 1. CaN7RACT PRICe "' Is 1.25% of contr�ct price with a(Minimum Fee of$50.�0)
<br /> $1311_00 x.012a $ $50.00
<br /> (cpntract price) (minlmum $50.00)
<br /> 2. STATE SURCHARG�
<br /> �1311.Da x .0005 $ $0.66
<br /> (contract price)
<br /> 3. P45TAGE � HANt]L.ING (�nly on Mall-In Appllcations) $ Z
<br /> �4. TdTAL PERM11' FEE (Add Lines 1-3 Above) � $'Z•�6
<br /> �` CONTRACT PRICE or J4B COST means the actual or estimated dollar amount charged for the
<br /> parmitC�d work Inciudlhg mate�rlals, labor, pro�t, and other fixed aosts, It 1� the amou�t to be charged to
<br /> the customer for the work done. lf any material, equipment, labor ar installations are fumished by the
<br /> ownar, 4enar�C or any ather pariy, the rea�onab[e market valua vf such items must be added to the
<br /> e�tlmated cost ar con'tt'�ct pr(ce for permit fee purposes. In the event that there Is a dlepute on the
<br /> amount of the job cast, the City may request the submission of a signed copy of the �ctual contl'act_
<br /> •;h}Jp: ��:1�q�,a f Ic.e�" - Ili i� •r��p11j::i!��u������i r�,Y'� �� -.`^{`���,
<br /> x� � � rr."�;
<br /> �"'S''.';-�= t�""�1:. •i��i��ij�ii�`� �r� •i x ,N'?'t.� .-y„h�_:. ,.i•:'
<br /> The underslgned hereby applies ta the City for issuance af a Plumbing Permi#, agrees to do all work in
<br /> strict sccordance with the ordinances of the C1ty antl the regufaxions oP the state of Mlnnesota, end
<br /> certifies that al1�t�Cements made on thls �ppllcatton are camplete,true and correct,
<br /> Applicant's Sign� r Date: �
<br /> _ � �.�
<br /> �ulld�ng Offic�aU lnspecxor: Date: �
<br /> ���z
<br />
|