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Jan 18 18, 11:52a p.3 <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT 1ST 2NO OTHER <br /> TYPE Floor Floor TYPE Floor Floor <br /> Water Closet I ., Floor Drains <br /> Lavatory t 3 Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower 1 Washer <br /> Kitchen Sink I Water Heater <br /> Disposal ) Water Softener <br /> r <br /> Dishwasher ) Wet Bar <br /> Sillcocks Miscellaneous <br /> PERMIT FEE CALCULATION <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a (Minimum Fee of$50.00 <br /> ivx.0125 $ r 4 1 tro <br /> ()t ontract price) (mini • m $50.00 <br /> 2. STATE SURCHARGE <br /> x .0005 $ I. C° <br /> (contract price) <br /> 3. POSTAGE & HANDLING(Only on Mail-In Applications) $ k5C1. <br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ ,,�0 5l 5V <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 1 <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 on this application are complete, true and correct. <br /> Applicant's Signature: 144�/ 0y1-e--e( Date: 1- /dO-/fi . <br /> Building Official/Inspector. Date: <br /> Page 2 <br />