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12/14/16 WED 10:55 FAX 6517741007 FOREMOST NECH Q003 <br /> FIXTURE BSMT 1sT 2ND OTHER FIXTURE BSMT 1sT 2"D 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 1 <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> T, C C 1�► . <br /> 1. CONTRACT PRICE ' is 1.25%of contract price with a (Minimum Fee of$50.00) <br /> x.0125 $ a <br /> (contract price) (minimum $50.00) <br /> 2. STATE SURCHARGE <br /> Q r -Q ce I,� 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 /> 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. <br /> Applicant's Si9 natur . c .. _Date: �/��' <br /> Building Official/Inspector: Date: <br /> Page 2 <br />