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<br /> FIXTURE SSMT t'r 2"'t' OTFIER FtXTtJRE t3SMT 16T 2"° OTHER . .... ... .. ....
<br /> TYPE Floor Floor TYPE Floor Floor
<br /> Water Closet Floor Drains
<br /> ........ .
<br /> Lavatory Sewer Ejector
<br /> Bathtub Laundry Tray
<br /> Shower Washer
<br /> m.�_ _—. _.___...._...- ......._— W. . ........•,,,,.,.,,.._ .___...,� .. �.-- --..._..._...._..._ ,.__........_._._.....__
<br /> Kitchen Sink Water Heater
<br /> Disposal Water Softener
<br /> Dishwasher Wet Sar
<br /> Sillcocks Miscellaneous
<br /> ,.-,. ......._..,..;.,.:...�..:�'33:,�`",�,.,-._.,:_;:,.�.r:.`-x:"•ca:_:-::.::`-::.��.A�..'"''`��'��,,jjjj C'�r: �c�' `����� >, s".. ,r,`rYt'e�;`.n,� rrJ�„h,�'"✓•'rr,r,, _
<br /> r_
<br /> i, CONTRACT PRICE *.is 1.25%of contract:price with a{Minimum Fee of$50.00)
<br /> 47. ... ,::0'.:C�+ S
<br /> (Contract price) (minimum$50.00)
<br /> 2. STATE SURCHARGE
<br /> � " � �
<br /> (contract price)
<br /> 3. POSTAGE& HANDLING (Only on Mail-In Applications) $ . 2.0
<br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above �
<br /> "
<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.. to the.event that there .is a dispute on the
<br /> ...amount of thejob cost, the City may request the submission of a 'signed copy of the actual contract..
<br /> , '{,r,•';;ti'rj-j;�\.e "•!F`�sr;'c3`'.
<br /> ,.r-.."� ..,.::.:;.: .—,�.:._5.5,�. •, ':^• .} cs '5;'^.:' ,\.nn�5,
<br /> ._.>,.,.:>aM-o .::^�:'"-<?,e.�tiv_;z::�L u;;;..,,,;•.., ..:'�' - �'� - - '�'* ..,. ,'<'�ryr.L7y`�'�,?,.•„�r„!�:
<br /> iawa.."fid`�,"„ey"�uw'�ohA..L�'iuS`J
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<br /> The undersigned hereby applies to the C,ily for isst; v€a Pl mu bin ermit, agrees to do all work In
<br /> strict accordance with the o:rdinonc6 of tha C6 and the regulations df the 'Mate of Minnesota, and
<br /> certifies that all statements eon this a.ppi tion ar cQrriplete,'traeCid-otirrect.
<br /> r
<br /> C)N'
<br /> Applicant's Signature; „ : "" Date:
<br /> Building:Official/Inspe'ctae:, gate,
<br />
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