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} <br /> .......... .. ........ _._.............._.._.._. <br /> [_--- PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 _OTHER <br /> ST ND S7 nu <br /> TYPE Floor Floor TYPE Floor Floor <br /> Water Closet ( Floor Drains 3 <br /> Lavatory ( ( Sewer Ejector <br /> Bathtub �. Laundry Tray <br /> Shower 2 Washer I <br /> Kitchen Sink z Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> F PERMIT FEE CALCULATION <br /> 1. CONTRACT PRICE ' i 1.25%of contract price with a (Minimum Fee of$50.00) <br /> l Sit k"a V x .0125 $ `7 3 S0 <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE <br /> y"70 x .0005 $ / <br /> (contract price) <br /> 3. POSTAGE & HANDLING (Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ �5 -7 <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 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. 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 /> PLUMBING PERMIT APPLICATION AGREEMENT —] <br /> The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all work in <br /> strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and <br /> certifies that all statements made opt application re complete, true and correct. <br /> Applicant's Signature: `''"'�� Date: l <br /> Building Official/ Inspector: Date: _ <br /> Pago 2 <br />