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Stewart Plumbing, Inc. 7634281733 p.3 <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1sT 2ND OTHER FIXTURE BSMT 18T 2ND OTHER <br /> TYPE Floor Floor TYPE Floor ! Floor <br /> Water Closet 3 Floor Drains <br /> Lavatory 3 3 Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower I Washer <br /> Kitchen Sink Water Heater <br /> Disposal I Water Softener <br /> Dishwasher Wet Bar I <br /> Sillcocks Miscellaneous <br /> PERMIT FEE CALCULATION <br /> 1. CONTRACT PRICE *is 1.250/a of contract price with a (Minimum Fee of$30.00) <br /> ,/7, 56 o-U x .0125 $ _5q3- 15 <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE �} <br /> 4,L/ 0•Uy 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) $ s1 q• <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 fxed 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: � '�- - ' l� �C17�-- Date: 9-,)3- 1-7 <br /> Building Official/ Inspector.- Date: <br /> Page 2 <br />