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11/03/2011 03: 24 6519948701 JANECKYPLUMBING PAGE 03 <br /> r <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE s is 125%of contract price with a(Minimum Fee of$50.00) <br /> x.0125 $ <br /> (contract price) (minimum 550.00) <br /> 2. STATE SURCR.ARG.E � - <br /> �� x.0005 $ <br /> (connect price) <br /> 3. POSTAGE&.HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) S 5-0 <br /> ■ * CONTRACT PRICE or JOB COST means the actualor 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 /> •AstA:tv,,., om.R 'o-lic�:� t��F '. r�"'?:,,o" M ���? m� .d„ru1 - ' I S I° _• , „. <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 /> �, ' X41 - _ <br /> Applicant's Signature: ' ��✓� Date: �� l <br /> 3 <br />