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Mar 1017 05:22p Legend Services Inc 763-479-6003 p.3 <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1ST 2N° OTHER FIXTURE BSMT 1sT 2ND OTHER <br /> TYPE Floor Floor TYPE Floor Floor <br /> Water Closet ( 11 Floor Drains I <br /> Lavatory + 3 Sewer Ejector <br /> Bathtub x Laundry Tray <br /> Shower Washer <br /> Kitchen Sink j Water Heater t <br /> Disposal ( Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks )L Miscellaneous <br /> PERMIT FEE CALCULATION <br /> 1. CONTRACT PRICE is 1.251/6 of contract price with a(Minimum Fee of$50.00) <br /> 1-0/0970 X.0125 $ 1;5` <br /> 2. STATE SURCHARGE <br /> (contract price) (minimum $50.00) <br /> t o, coo x.0005 $ 5 <br /> (contract price) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ pp <br /> 4, TOTAL PERMIT FEE(Add Lines 1-3 Above) $ 130 <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 /> PLUMBING PERMIT APPLICATION AGREEMENT <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 Signature: per: <br /> Building Official/Inspector: Date: <br /> Page 2 <br />