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08/11/2015 14:18 FAX 95293�5049 CULLIGAN MNTKA �004
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<br /> If�bo��e does not ap�iy;folIow guidelines bclow: , •
<br /> 1. CONT�CT Pk�C� * is ].?�%o�cantract price with a(Aqinemum Fee of�50.00)
<br /> x.0125�
<br /> (contraci price) (.ninimum$50,00)
<br /> 2, STAT�_SY.i�iCY�Al2C� **Add the State Bldg Code Div.Surcharge(Minimum�ee of�5.00)
<br /> x.0005 $
<br /> (contract pricc) (minimum$ 5.00)
<br /> 3. POSTAGE&HANDLING(Only on MaiI-In Applications) � �,00
<br /> 4. TOTAI.,�EYt114TT�'EE(Add Lincs 1-3 Abo�c) �_ � t� , d V �
<br /> ■ K CONTRACT PRICE or JOB COST means the actual or estimated dollar amount chargcd for tho
<br /> perRiitted worlc inciuding materials, labor,profit, and other fixed costs. It is the amount to be eharged
<br /> to the customer for the work done. [f any material, equipmenC, lt�bor or instAll2�ions are furnished by
<br /> tl�e owner,tcnant or any other pazty, the reasonable market value of such itesns must be added to the
<br /> csCimaied cost or contract price for permit fee purposes. ln the event that there is a dispute on the
<br /> amount of Ehe job cost, the Ciry may request the submission of a signed copy of the actual contract.
<br /> ■ '"*The STATE SURCHARGE is.0005 of the contraet priee under�1,000,000 or$5.00—whichever is
<br /> greatcr_ For valuations ovcr$1,000,000 call�hc Building Depanment 0.t(952)249-4600 for the piice.
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<br /> The undersigned hereby applies to the City for issuance of a 1?lumbing Permi� agrees to do all
<br /> work in strict accordance with the ordinances of the City and the regulations of the 5tate of
<br /> Minnesota, and certifies that a1] statements made on this application are compiete, true and
<br /> correct.
<br /> Applicant's Signature: � �c�.�z Date: X - I I - I�
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