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11/06/2015 11:29 FAX 9529�35049 CULLIGAN MNTKA C�O10
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<br /> y-7 " 7-� �y�y ' y� �'A 01'�; � =J�gS`QVER�'�50�':DO��� ��, �� , � ,-
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<br /> Tf above does not apply;follow guidelincs below' � • ' '
<br /> 1. CONTRACT�RYCE *is X 25%of contract price witl�a(Minin;rum Fee of�50.00)
<br /> x.0125$
<br /> (contract price) (minimum$50,00)
<br /> 2_ STA,T�SYJRCEit�T�tG� **Add the State Bld�;Code Div.Surcharge(M�nimum�ee of$5.00)
<br /> x_0005 $
<br /> (wntract pricc} (minimum� 5.00)
<br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
<br /> 4. TOTAL PERMIT FE�(Add Lines 1-3 Above) � •�4
<br /> ■ * CONTRACT PF�C�. or 70B COST mesns the actual o[ estimatcd dollar amount charged for the
<br /> permitted work inciuding materials,isbor, profit,and other fixcd costs. It is che amount to be charged
<br /> to tho eustomer for the work donc. If any matcrial, equipmcnt, labor or inssal3ations are fumished by
<br /> thc owner,tenant or any other party,the reasonable markct value of such items must be added to thc
<br /> estimated cost or contTact price for permit fee purposcs. In tfte evenC th�t there is a dispute on the
<br /> amount of thc job cost, the City may rec�uest the submission of a signed copy of the actual contract.
<br /> ■ '"*The STAT�SURCHARGE is .0005 ofthe contract price under$1,UOO,Q00 or�5.00—whiehever is
<br /> greater. For valuations pver�1,000,00�cal!thc Building Dapartment at(952)249-4600 for the price.
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<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 Ciry �nd the regulations of the State of
<br /> Minnesota, and cercifies that all statements made on this applieation are complete, vue and
<br /> correct.
<br /> Applicant's Signature: Date: ��"_�- �J _
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