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03/27/2018 12:21 FAX 9529335049 CULLIGAN MNTKA C�005 <br /> . • <br /> " ;"� PLUMBING FIXTURES BEI;NG.INSTALLED °;. ,' F - <br /> FIXTURE BSMT 1sT 2ND OTHER FIXTURE BSMT 1s� 2ND OTHER <br /> TYPE Floor Floor IYPE Floor Floor <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Neater <br /> Disposaf Water Softener � <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> .. PER1VlIT FFE CALCU'LA�TtO' ' <br /> _ �' � �� � , ; R , ';:, � � � � �{ , � <br /> ,. .�. ,,,:�. ... .: . � , . �1 � <br /> �� 1. CONTRAC�PRiCE-*is 1.25%-of contract price with a (Minimum fee of$50.00) � � - <br /> a b0, � U x .0125 $ -S�• �� <br /> (contract price) (minimum $50.00) <br /> 2. STATE SURCHARGE <br /> x .0005 $ <br /> (contract price) <br /> 3. POSTAGE & FfANDLtNG (anly on Mail-In Applications} $ 2.00 <br /> I� <br /> 4. TOTAL PERMET FEE (Add Lines 1-3 Above) $ �a� <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dolfar amount charged for the <br /> permifted work including materials, 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 installa4ions are furnished by the <br /> owher, tenant or any �ther party, the reasonable market value of such items musf be added to the <br /> estimated cosf or contract price for permit fee purposes. !n 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 actuai contract. <br /> ; � . - �� , � <br /> k , �,;y ' .1; r., PLl1MBING PERMfT:APRL'I��T1.ON ACR�EN[�NT� � ` <br /> , �, <br /> The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all work in <br /> strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and <br /> cerfifies that all statements made on this application are complete, true and correct. <br /> Applicant's Signature: � Date: 3- a7 - �� <br /> Building OfficiaU fnspector; Date: <br /> Page 2 <br /> � <br />