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12/22/2010 13:57 FAX 9529335049 CULLIGAN MNTKA C�004 ,.. .� , .�•- � yo� ,y ..�. ��r i; � ,, _ ,`....�.;-- ,� , r��: ':::yp_'t'�- � ..,`!_ i.y.s j��, r ii G F' �t� i 7 I .t.�""'�1. �E�;�"',�ji:j'yt,- a,a-.:ic'7;�;:;i�yC:r�.�sd�k.. '�..i',;`�..t� �� _ 'xi..,�� "� .t.� ��.�b,(z�iu�„w�in�4i ;�',J:,_.,;= i 'L.: If above does not apply;follow guidelines below: I 1. CONTRACT PRICE * is 1.25%of contract price with a(Miaimum Fee of$50.00) x.0125$ (conaact price) (minimum$50.00) 2. STATE SURCHARGE *'`Add the State Bldg Code Div,Surcharge(Minimum Fee of 55.00) i x.0005 S (contract price) (minimum S 5,00) ' 3, POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 i 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �.0� ■ * CONTRACT PRJCE or JOB COST means the actual or estimated dollar amount charged for the permitted work including materials, labor,profit, and other fixed costs. ]t is the amount to be charged to the customer for the work done. If any material, equipment, labor or installations are fumished by the owner,tenant or any other parry,the reasonable market value of such items must be added to the estimated cost or contract price for permit fee pwposes. In the event that there is a dispute on the amount of th�e job cost, the Ciry may request the submission of a signed copy o�the actua] contract. ■ **The STATE SURCHARGE is.0005 of the contraet prica under$1,000,000 or$5.00—whichever is greater. For valuations over$1,000,000 call the Building Depariment at(952)249-4600 for the price. � - �� •t �,rt��.� The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all work in strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements made on this application are complete, true and correct. ApplicanYs Signature: Date: �a'o�-� (� � �;.` r i-c�; R��i��Of�tT1�= 3