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10/O1/�2010 15:11 FAX 9529335049 CULLIGAN MNTRA f�004 <br /> „r .c^ � ..•6. 'v t('��Jbf,i, ����;-`�,: 's`� <br /> 'st:. 1�`.(+L•A,.�F. ....V,'i: Fi. .4, ! ..+':% '� �� .t7;'•'::e:tl`7:[n <br /> '•istY:(.�4'w:• :,�'T�� l:f <br /> �W <br /> If above does not apply;follow guidelines belaw: <br /> 1. CONTRAGT PRYCE * is 1.25%of contract price with a(Minimum Fce of SS0.00) <br /> x.0125$ <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE '"*Add the State Bldg Code Div.Surcharge(Mioimum Fee otS5.00) <br /> x.0005 $ <br /> � (contracl priu) (minimum S 5.00) <br /> 3. POSTAGE&HANDLING(Only on Mail-Tn Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) S <br /> • � CONTRAC'f PRJCE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work including materiels,Iabor,profit,and othu fixed costa. It is the amount W be charged <br /> to the customer for the work done. If any material,equipment,'labor o�installations are fumished by <br /> the owner,tenant or any other party,the reasonable market value of such items must be added to the <br /> estimated cost or eontract 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 pf a signed c,opy of the actual contract. <br /> ■ **The STATE SURCHARGB is.0005 of the contract price under$],000,000 or$5.00—whichever is <br /> groater. For valuations over SI,000,000 call the Building Depertment at(9S2)249-4600 for the price. <br /> T6e undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all <br /> work in sfict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that all statements made on this application aze complete, true and <br /> correct. <br /> ApplicanYs Signature: ate: J� � � <br /> � , <br /> 3 , i <br />