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12/19/2011 14:14 FAX 9529335049 CULLIGAN MNTKA C�004 <br /> ' ._ � <br /> lyx-�:91 :�u. i�� �4 .::I�, . . _ ' ' ':I�.r: ' - ,�...F'.,1.�,:3.�.'It�. .. <br /> jf'(� i � ,��7v�(?i"� j�} .�,��� �: �t`.'1t <br /> t�;''�,'.7:��'���?��r,' v " F r".�,k� �Ci .�� :,��� '������ .L. '..� i v��ip"�j�i.ti�!.�.,��i4rn'{��(�:'�'ia�'} <br /> ,._ .:��:;' �.�' �.. :�: �a a' ,._ .�.. _ <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 550.00) <br /> 2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(Minimum Fee oiS5.00) <br /> x.�005 S <br /> (contracrprice) (minimumS 5.00) <br /> 3. P05TAGE&HANDLING(Only on Mail-In Applications) a 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) S ��•�v <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 aze fumished by <br /> the owner, tenant or any other parry, the reasonable market value of such items must be added to the <br /> estimated cost or contract price for peRnit 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$1,000,000 call the Bui(ding Department at(952)249-4600 for the price. <br /> �� �. ,. �y .��� ; � , p• � <br /> .� " � `� r.c.. _ _ �� +� e„ .._ <br /> The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that all statements made on this application are compfete, true and <br /> correct. <br /> Applicant's Signature: Date: I� — IcI ' (� <br /> '���'�$f�l , <br /> �.,� . �R � _ <br /> 3 <br />