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, PLUMBING FIXTURES BEING INSTALLED <br /> . , <br /> �FIXTURE BSMT 1sr 2ND OTHER FIXTURE BSMT 1sr 2ND OTHER <br /> TYPE Floor Floor TYPE Floor Floor <br /> Water Closet � Floor Drains i � <br /> Lavatory � �j Sewer Ejector <br /> Bathtub � � Laundry Tray � � <br /> Shower � Washer � <br /> Kitchen Sink � Water Heater � <br /> Disposal � Water Softener <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 /> J�l��, �'J x .0125 $ ( � r <br /> (contract price) (minimum $50.00) <br /> 2. STATE SURCHARGE <br /> c:7�� <br /> x .0005 $ � ` ` <br /> (contract price) <br /> 3. POSTAGE 8� HANDLING (Only on Mail-In Applications) $ 2 �� <br /> 4. T TAL PERMIT FEE Add Lines 1-3 Above `�� <br /> O ( ) $ <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 <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 /> , <br /> Applicant's Signature: Date: 2—r7-�� <br /> Building Official/ Inspector: Date: <br /> Page 2 <br />