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12/14/2015 14:05 FAX 9529335049 CULLIGAN MNTKA 007 <br /> •:vr• n .',•jr.a'� r i' � 'iii � i,i�•s:Lt�a'• r a>•� <br /> kit ,•,;;�iyi,,,;.•;r�•.,.�:��TE T EE:E �tj•-, r'.°�'IO S. '�'r }FjS070 500:004•',.r :.,}•,• -:,�;;;:;,'"'' i�; <br /> �,�Ntl:�}�°i'��,:4i'r'i'rr��^n.•i� 'I R'` Nl' �":7�,tt1 �P• r �1�� ry4r.r'�.�;T'..,.':1 <br /> s <br /> If above does not apply,follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of 550.00) <br /> x-0125 5 <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(Minimum Fee of 55.00) <br /> x.0005 S - <br /> (contra=price) (minimum$ 5.00) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) S _ 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 <br /> to the customer for the work done. If any material,equipment, labor or installations are furnished by <br /> the 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 STATE SURCHARGE is.0005 of the contract price under$1,000,000 or$5.00—whichever is <br /> greater. For valuations over 51,000,000 call the Building Department at(952)249-4600 for the price. <br /> y ;,c•«} ID� �( ��td' �i as A ! }t" i �l''��� tP °�rutYl �Yvr den,•��<,t,�'�� <br /> .���!Y�..lf°.;".`.tn.P. IL;�i.�'(;N,tlm�r.�'��� �.Y'�l'� T1(��1 t�'lY�A��.:T'. `v�w�•��rrY�^/I�����,3,i41r�i+�ei;�'G;%'.r.%�. <br /> The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that al] statements made on this application are complete, true and <br /> correct. <br /> 1 <br /> Applicant's Signature: Date: I - 14-- r 5 <br /> ,Ke �'�rFrr k <br /> s li,7!•,•,OTmr, <br /> 3 <br />