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07/25/2013 09:25 FAX 9529335049 CULLIGAN MNTKA l004 <br /> Y 4 '1 <br /> . PERS%I, FE ; ALL SL.r TION( )-1:101 0.V:t =$SQ 'OQ , . :` <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$5000) <br /> 2. STATE SURCHARGE **Add the State Bldg Code Div.Surcharge(Minimum Fee of$5.90) <br /> x.0005 $ <br /> (contract price) (minimum$ 5.00) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ Qa • Ob <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 /> '�"n;i�l�. �[ rr4'F�a;t'«-. � �.�,. �.�;.. ', "..t. .,�:„,�'t,,"gy{ ,•�^.� tti '?�I�J„��-,4',A4iTMe ,FL:'.i�iii r,�"•I <br /> ,k•Ti s'I 7ti t r.5 }i} t" :�'- ! tn. 'it;'17 r A !-• �'!�'•, i•{�; ,,,,i,%i:Qq i4:,;.�::t�I f�, <br /> �tr�it..y �'�-��t2rf:wIG��EIc,.'���:� � ��E�� , . .,..., ���, i!' r .w� z•.r. ,-'!: .g <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 /> 4 , <br /> Applicant's Signature: Date: 7 ' 015 - 13 <br /> ltr <br /> I” til. !�k1'` t r <br /> i sev rOa' q <br /> Y,'n! .};'+.aitch. ...T.: <br /> 3 <br />