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I 04/12/2012 15:16 FAX 9529335049 CULLIGAN MNTKA 1�004 <br /> I , . <br /> -��.�,:. � .', n,. ,r� - y t':T` FS."."' <br /> _' iaii;:;i'� ;��('+,'ii;/;�� s i;;A� �r� v ., .g:; ,�r�';:�;��- ac�Ct <br /> :',�.jl+� i4.�.i�f•5�;� 2. 1 i: i� .S: 7:�: :.;ti:i� J � r' t'�:.�f": <br /> .,�.�'' '�.: `�;.4r� ��;Qa.".: u$,. ' '�i��i�Y;..�. �•'r r y1 <br /> `!�,',, <br /> ( �t��,�{,�.,•ie#t 't:i�^'��':.il. �,' .�..i�', r3.� t <br /> ]f above does not apply;follow guidelines below: <br /> l, CON'�'RAC'T PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> � x.0125$ <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE '�*Add the State Bldg Code Div. Surcharge(Miaimum Fee oiS5.00) <br /> x.0005 $ ' <br /> (wntrac�price) (minimum S 5,00) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> _ 4._TOTAL PERMIT FEE(Add Lines 1-3 Above) $ o�a- � � <br /> ■ * CON1'RACT 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 wotk done. if any material, equipment, tabor or installations are fumished by <br /> the owner, tenant or any other party,the reasonablc market value of such items must be added to the <br /> estimatod 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 /> � <br /> ■ *" The STA'i`E SURCHARGE is .0005 of the contraet price under$],000,000 or$5.00—whichever is <br /> greater. For valuations over$1,000,000 call the Building Departrnent at(952)249-4600 for the price. <br /> '�i t ' I�f � +'� �1' I 1 ,ri r <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 reguiations of the State of <br /> Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> � <br /> Applicant's Signature: �GG�'"����G�ir-� Date: '� Z ' <br /> q� ia�fl <br /> ��SB��4�� :• <br /> �.� �R��:�:f�w� <br /> I <br /> I ' 3 ` <br /> 1 <br />