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• 08/21/2017 13:39 FAX 9529335049 CULLIGAN MNTKA �J003
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<br /> FIXTURE BSM7 1sT 2"o OTHER FIX7URE BSMT 1sT 2ND OTHER
<br /> TYPE Fioor Floor 7YPE Floor Floor
<br /> Water Cioset Floor Drains
<br /> Lavatory Sewer Ejector
<br /> Bathtub Laundry Tr�y
<br /> Shower Washer
<br /> Kitchen Sink Water Heater
<br /> Disposal Wafer Softener (
<br /> Dishwasher Wet Bar
<br /> Siflcocks Miscellarieous
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<br /> 1. CONTRACT PRICE * is 1.25% of contract price with a (Minimum Fee of 550.00)
<br /> a8`�9 �a x .o�2s � 6s. i� I
<br /> (contract price) (minimum $50.00)
<br /> 2. STATE SURCHARGE
<br /> x .0005 $ � •y �
<br /> (contract price)
<br /> 3. POSTAGE � HANDLiNG {Only on Mail-In Appli�ations) $ 2.00
<br /> 4. TO7AL PERMIT FEE (Add Lines 1=3 Above) $ ��• d�
<br /> * CONTRAC7 PRICE or JOB COST means the actual or estimated dollar amount charged for the
<br /> permitted work including mat�rials, labor, profit, and other fixed costs. It is the amount to be charged to
<br /> the customer for the work done. If any material, equipment, labor or installations are furnished by the
<br /> owner, tenant or any other party, the reasonable market value of such items rrtus# be added to the
<br /> estimated cost or contract price for permit fee purposes. 1n.the event that there is a dispute on the
<br /> amount of the job cost, the City may request fhe 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 al! work in
<br /> strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and
<br /> certifies that all statements made on this application are complete, true and correct.
<br /> Applicant's Signature: � Date: �'01 � - I �
<br /> Buiiding Officiall lnspector. Date:
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