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fIf SIJs <br /> l�Lt MBI,IVG FIXTURE BEING INS T' <br /> FIXTURE BSMT 1sT 2N0 OTHER FIXTURE 1 !I MT 1s 2ND OTHER <br /> TYPE Floor Floor TYPE Floor Floor <br /> - _ <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer il; <br /> ter-- <br /> Kitchen Sink Water Heater 14i' <br /> Dispose! Water Softener 77 <br /> Dishwasher i Wet Bar <br /> Slilcocks Miscellaneous tri <br /> P liMIT;FE.OALCULAT1;ON <br /> 1. CONTRACT PRICE is 1.25% of contract price with a (Mi 1,1 <br /> urn Fee of$50.00) <br /> l i e.)Ol2, UrJ x .0125: ' $ <br /> (contract price) i� (minimum$50.00) <br /> 7. STATE SURCHARGE <br /> x .000 $� <br /> (contract price) <br /> 3. POSTAGE& HANDLING (Only on Mail-In Applications) II i $_ 2.00 <br /> r <br /> 4. TOTAL PERMIT FEE (Md Lines 1-3 Above) � $ <br /> * CONTRACT PRICE or JOB COST means the actual or estimat� dollar amount charged for the <br /> permitted worK Including rnalerials, labor, profit, and other fixed costsli I G is the amount to be charged to <br /> the customer for the work done. If any material, equipment, labor oi;��l� stallations are furnished by the <br /> owner, tenant or any other party, the reasonable market value of h items must be added to the <br /> estimated cost or contract price for permit fee purposes. In the e , u that there is a dispute on the <br /> amount of the job cost, the City may request the submission of a -,°1''ed copy of the actual contract. <br /> PLUMBING PERMIT APPLI, ATIONSAG 111E IT <br /> The undersigned hereby applies to the City for issuance of a Plumb!, `Permit, agrees to do all work in <br /> strict accordance with the ordinances of the City and the regulatio 'I of the State of Minnesota, and <br /> certifies that all statements made on this application are complete,tru` -nd correct. <br /> ; I <br /> Applicant's Signature: 1 L Date: g' 9-/ <br /> Ii1 <br /> SII ,l <br /> Date: <br /> Building Official/ Inspector: 1I , <br /> Page 2 <br /> 2/Z8 30dd JNISWNld AlIE 770 ZZbTEZ6Z56 Sb:aT 8TeZ/ZT/Ee <br />