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„�'/2B/2017 11:33 FAX 9529335049 CULLIGAN MNTRA I�003
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<br /> FIXTURE BSMT 1sr 2ND OTHER FIXTURE BSMT 1s-r 2ND OTHER
<br /> 7YPE Floor Ffoor TYPE Floor Floor
<br /> Water Closet Floor Drair�s
<br /> Lavatory Sewer E}ector
<br /> Bathtub Laundry Tray
<br /> Shower Washer
<br /> Kitchen Sink Water Weater
<br /> Disposal Water Softener �,
<br /> Dishwasher Wet Bar
<br /> Silicocks Miscellaneous
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<br /> 1:• EONTRACT�PRICE '` is 'E.25% of contract price with a (Minimum�Fee of$50:OOj �- � � �� � �
<br /> o�C70• v� x.0125 $
<br /> (contract price) • (minimum $50.00)
<br /> 2. STATE SURCHARGE
<br /> x .0005 $
<br /> (con'tract price)
<br /> 3. POSTAGE� HANDLING (Onfy on Mail-In Applications) $ 2.00 �
<br /> 4. TOTAl. PERMIT FEE (Add Lines 1-3 Above) $ .Sa. o�s
<br /> * CONTRACT PRICE or JOB COST means the actual or estimated dolEar amount charged for the
<br /> perrnitted work including materiais, labor, profit, and other fxed costs. It is the amount to be charged to
<br /> the customer fvr the w,ork done. If any material, equipment, labor or installations are fumished by the
<br /> owner, fenant or any other party, the reasonable market value oi such it�ms must be added to fhe
<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 applies to the City for issuance of a Plumbing Permit, agrees to do a!I work in
<br /> strict accordance with the ordinances of the City and the .regu(ations of the State of Minnesota, and
<br /> certifies fhat a!1 statements made on this application are complete, true and correct.
<br /> � � Date: ��- a� 1
<br /> Applicant s Signature:
<br /> Building Officia(/ Inspector: Date:
<br /> Pags 2
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