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09/29/2016 04:28 6519948701 JANECKYPLUMBING PAGE 02 <br /> Y? <br /> FIXTURE BSMT IST 2ND OTHER FIXTURE BSMT 15T __2N5__ OTHER <br /> TYPE Floor Floor TYPE Floor Floor <br /> Water Closet Floor brains <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 /> 1. CONTRACT PRICE *is 1.25% of contract price with a(Minimum Fee of$50,00) <br /> G ' <br /> 06x .012.5 $ •EJU <br /> 2. STATE SURCHARGE (contract price) (minimum$50.00) <br /> LtUw - U <S x.0005 $ <br /> (contract price) <br /> 3. POSTAGE& HANDLING (Only on Mail-in Applications) $ 2.00 00 <br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ U <br /> CONTRACT PRICE or JOS 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 rrpde on this p cation are complete, true and correct. <br /> 4�Applicant's Signature: Date: <br /> Building Official/Inspector: Date: <br /> Page 2 <br />