|
03/14/2018. 13:13 FAX 9529335049 CULLIGAN MNTKA f�003
<br /> .
<br /> . ; ; � �� � -. P�L�tM.B.[�G-FI�CTUR-ES,�`BEI,NGIMSTALLE�3; '-54� tT� � �
<br /> # ,. _ ,::
<br /> FlXTURE BSMT �sr 2Nn OTN�R FIXTURE 8SM7 1sj 2ND OTHEf2
<br /> TYPE Fioor Floor TYPE Floor Floor
<br /> Water Closet Floor Drains
<br /> Lavatory Sewer Ejector
<br /> Bathtub Laundry Tray
<br /> Shower Washer
<br /> Kitchen Sink Water Heater
<br /> pisposal Wafer Softener �
<br /> Dishwasher Wet Bar
<br /> Sillcocks Misceilaneous
<br /> ._... .... _...,......:..._....... : ..,:. ,.,. .:..::.,�::.: .,.,: ..�... . ... . :....,:. - - - -- - - ,�:r...
<br /> .�. .�.... .. ................��.x.,.n�.. r:�_:.. a .. ' .� � , ..;..._:... - e:CS `Yur'?:::.;�;;; _ ' _ _ _
<br /> i "S '�.r�.:�:� :.s.;.... -_ _ ';.y�.
<br /> ..,.._.. K..��...,;_...�.�.�..a..� �::,:�.�_�.t..+.:.r. ...:.::...��:., ...��. ..a . j. ' _
<br /> �.�...�.���y, ,�_ ..�...a_.9.,...,Y ..d ... ,. .I .. ..., , :.:s.. . ,. . ::.. .�: �'c'S...�..ti�..�a�.z �3�'�'i"!'g;'
<br /> ,.�:,,�F�....� �_�_.,.,., ,...x..1...,. ,ia,� „�,.,�: : :--. .... .,...,,..+.� , . _. �.: 'I., : �,g.y.�.i ';,� �zv,,�°„�:w-, .i...
<br /> _ .w. ... ,:�:...�E .�.: G....ew4_��.�.-.,.��..z"�.._�:.�_�.:,. �.. .. .... �� :x�d..i. 3.�,��s:_::�;""� w�.: .'�..., ,_�. �i...:
<br /> .:���,.x:.�,��.,.�n.r.::.:.. . . n�,,.,..,:.k',x �.:3:..=:�:.-,�.-.:�.,.....ia.,.��..;�_s _ :tz �R�: ..u.���.�,.n.
<br /> � ... .�._...,.. . .,� „�� � ,....._.. . :......:�.E��1T:..�;. E.�i. tAT�f3 � rrixx���.�.� :::�.._,��.,::�:.:.,...
<br /> ,�..:K����:_�.�..,ax.:.,,.:..���.x�,��.,.�...��,��,.�,:�........_....r,���.r..,...—.•.��-...._......�.�..__.__....... ......�.�.. ..�,�.:a::; _
<br /> -1. CONTRAC�'PRfCE *is 1.25% of contract price with a (Minimum Fse of$50.04) ��- � �
<br /> �� y �• �0 x .0125 $
<br /> (contrac# price) (minimum $50.00)
<br /> 2. STATE SURCHARGE
<br /> x .00Q5 $
<br /> (contract price)
<br /> 3. POSTAGE � HAN'DLING (Only on Mail-In Applications) $ 2.00
<br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ -SO�.�� ��
<br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the
<br /> permitted work including maferials, labor, profit, and other fixed costs. It is the amount to be charged to
<br /> the'customer for the work done. tf any material, equipment, labor or installations are furnished by the
<br /> owner, tenant or any other party, the reasonable market value of such items must be added to the
<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.
<br /> , � . .. , ,...,.., .. �. _ ,,, .. ..,-. .
<br /> . �:a .. .. .:.: ... ..� .. .., ;�,, .._:r,. ,�,.-e.._�. ., ;ar� xr.y::,•F.a .n.:rk�K�;;:,,�`:;r�•�
<br /> P3i:v' ._�,:;.,.�•:�.t-`�...'. . _. .: _
<br /> 4.1... �._.
<br /> -� �,
<br /> . ...,;r. �. ",',C�,.. ,i�*:C isi:,�!' ;�ry
<br /> a .-zz u —
<br /> i:r: -�i�°.�., :�.�•;'i;:,xk.�r:'�:o��s:�
<br /> w,r�. ._. -. , ,.;:::.. k=M''t. "'� " . r�� � �IF'? .�fl. i.
<br /> ,:......,
<br /> _-,. F� ��� . . ....._. ; „..;;,. r.
<br /> ...,
<br /> ,..�. : ..
<br /> �
<br /> $:�. . �����:__..::�.: ����L��tI�:�I�l.G�p�RMI�:����avE����s-�k�k��� :�.;�..�,.�.,,,.,�:.:.:.�::4}...u��,..���:.�.��,�a��,:._k.,:�:����.:.
<br /> �..�_. _. .
<br /> f�.A.� �:�.,...._ �_� .�.:.��,a4._�....,�.........:..... � -
<br /> The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do afl work in �
<br /> strict accordance with the ordina�ces of the City and the regulations of the State of Minnesota, and
<br /> certifies that all statements made on this appfication are comp{ete, true and correct.
<br /> ApplicanYs Signafure: � Date: 3' ��- � g
<br /> Building Official/ Inspector: Date:
<br /> Paqe 2
<br />
|