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Apr, ll. 2016 3:44PM Norblom Plumbing No- 3246 P. 3 <br /> IMMi.,vo,`�w,u� E�14C�h,^'�V'S7i a7'LL6D <br /> FIXTURE SSMT 1sT 2ND OTHER FIXTURE BSMT 1v 2ND OTHER <br /> TYPE Floor 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 /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> PERMIT PEE CALCULATION _ <br /> 1. CONTRACT PRICE is 1.25% of contrra�ct price with a(Minimum Fee of$50.00) <br /> Z, 06v <br /> X .012 1 150 5 $ - <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE <br /> x .0005 $ <br /> (contract price) <br /> 3. POSTAGE&HANDLING (Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL.PERMIT FEE(Add Lines 1-3 Above) $ <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted 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 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 /> i <br /> Wi� ':', 'PLUMBING PERMIT APPLICATION AGREEMENT 1 <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 /> certifies that all statements made on this application are complete, true and correct.1 <br /> Applicant's Signature: Date: L <br /> Building Official/Inspector: Date: <br /> Page 2 <br />