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0 <br /> FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT 1ST 2ND OTHER <br /> TYPE Floor Floor TYPE Floor Floor <br /> Water Closet _5 9 1 Floor Drainst 11 <br /> Lavatory l Sewer Ejector <br /> Bathtub l Laundry Tray <br /> Shower Washer I <br /> Kitchen Sink 3 Water Heater I <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> � . <br /> r"aur % +r 4'' <br /> 1. CONTRACT PRICE * is 1.25% of contract price with a (Minimum Fee <br /> of$50.00) <br /> ',(?at l x .0125 $ ,isJ6.a5l) <br /> (contra6t price) (minimum $50.00) <br /> 2. STATE SURCHARGE <br /> c> <br /> i•O`i 000 x .0005 $ /q3--U <br /> (contract price) <br /> 3. POSTAGE & HANDLING (Only on Mail-In Applications) $ "-2-.00 – <br /> w' <br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ 30/ <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 /> v tea. P' i4.,L :, ..:t''v 4 <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: - i•V C-f Date: 3 r�v�1 <br /> BuildingOfficial/ Inspector: �' Date: - ` 7//7 <br /> P �% � U (' <br /> Page 2 <br />