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06/18/2013 12:02 FAX 9529335049 CULLIGAN MNTKA la 004 <br /> p� FSE cAGL}LIToT( � os;aVR: s,00do <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> x.0125$ <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(Minimum Fee of$5.00) <br /> x.0005 $ <br /> (contract price) (minimum S 5.00) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL.PERMIT FEE(Add Lines 1-3 Above) $ 0a- ov <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$1,000,000 call the Building Department at(952)249-4600 for the price. <br /> ;r..h„„�.,; r �4t ..,,... ,.�„ r,',��. � .-y., <br /> 0,kN;r'"r,.� k�{;1 ,�,��'t 15.1 '� :[,,.,'�'�ra e { <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 all statements made on this application are complete, true and <br /> correct. <br /> (1Applicant's Signature: Date: y 18- 13 <br /> ;inrx1841 <br /> ilAe4PF j" 3 <br />