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12/14/2016 09:04 FA% 9529a35049 CULLIGAN MNTKA 1�003 <br /> e. <br /> �1 y�� �j /�� 1�1., �r!;������wmr�,,��4mU1 y1�yn�Y�i��i�:IV:ILwI�y�"fi�����M <br /> �i6w�.I.�T/lil� � ���w��M q�iiMFv p� �IR 11�, T}�t~L��i�� r� K�Ix��YN <br /> • b��MI�+iY ���qi:,y�w�wN � � V�1��\E ���B��N,�1���1�(u.:� � �'�',�Y4h�lr�i���lilNilniuM�.�i.I �nnhFlliH�wnnno <br /> !hy+u'Mi',,;��isxya�.,:.,'�A 7���;' ,.:.�i���,,;��+�lx,��,N�7��� .��,'�„ <br /> FIXTURE BSMT 1ST 2ND OTH�R �IXTURE BSMT 1� ZND OTHER <br /> TYPE Floor Floor TYPE Floor Floor <br /> Water Closet Floor Drains <br /> l.avatory � Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water SofEener <br /> Dishwasher Wet Bar <br /> Sillcocks Misceflaneous . <br /> �p�.l.�..jj rR p "� �y� ryp��y{�j i � Rtiqwi��y�p`.'�'�l(i�.��y�",,,'r"i",.�rw!'��f*!� ���,'y���p� �� ^�aM�'^ <br /> ��ri ryY��fl.�����u..�.��..�'^.GL,�flarrn����������w iNw���4�W\'Miw�hw�iiy��w.��.�.:Y!'^Ia 1•u bril�abw`�we�:_.�°11 <br /> n4���JI�.K�.�.. M <br /> 1. ,CaNTRACT PRICE * is 1.25% of contract p�ice wi#h a(Minimurn Fee of$50.00) <br /> So� ' <br /> x_0125 $ <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARG� <br /> x .0005 $ <br /> (contract price) <br /> 3. POSTAG�&HANDL[NG (Only on Mail-In Applications) � 2.00 <br /> 4. TOTAL PERMIT F�E (Add Lines 1-3 Above) � �a� � <br /> * CONTRACT PRICE or JOB CaST means the actual or estimated doHar amount charged for the <br /> permitted work including materials, labar, profit, and other fixed costs. !t is the amount to be charged to <br /> the custorner for the work done. If any material, equipment, labor or installations are furnished by the <br /> owner, tenant or any other parky, the reasanable market value of such items must be added to the <br /> estimated cost or contracF price for permit fee purposes. In the event that ther.e is a dispute on the <br /> amqunt of �he job cost, the City may request the submissian of a signed copy of the actual cvntract. <br /> ���i`.���^� '°�'„'.�"'7CWA!Yl�n '�m���1,�,�,f.711��1�7�.�..'��F'�����•:i�4wirnii���"1''�'1_�'��I�:,�r '���� i.��°���� N��"Y.f�V��. i�•iq�� <br /> i <br /> The undersigned hereby applies to th� City for issuance of a Plumbing Permit, agrees to do all work in <br /> strict accordance with the ardinances of the City and the regulations of the State of Minnesata, and <br /> certifies that all statements made on this application are complete, true and eorreck- <br /> Applicanf's Signature� Date: � - (`f- !�e <br /> Building Official/[nspeotor: Date: <br /> Page 2 <br />