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11/18/2014 14:02 FAX 95299�5049 CULLIGAN MNTKA �004
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<br /> If above does not apply;follow guidelines below:
<br /> 1. CONTYtAC7'PXZiCE *is]25%of contract price with a(Minimum Fee of$50.00)
<br /> x.�125�
<br /> (contrnct pricc) (minimum$56.00)
<br /> 2. STATE SURCHARGE �*Add thc Statc Bldg Code Div. Surcharge(A�Iinimum�ee of�5.00)
<br /> x.0045 $ �
<br /> (conaae[price) (mioimum S 5,00)
<br /> 3. POSTAGE&HANDLING(�nly on Mail-In Applications) $ 2.OQ_
<br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 ABove) � �e, (�l�
<br /> ■ '� CONTRACT PRTCE or JO$ COST means the actual pr estimated dollar amount charged for the
<br /> permitted work inc)uding maferials, labor,profit,and oth¢r fixed costs. It is the amount to be charged
<br /> to thc customcr for thc work don�. If any material, equipment, labor or instAlIations are fvmished by
<br /> thc orvner,tenant or any other parry,the reasonable market value of such items must be added to the
<br /> es[imated cost or contraet price for permit fee purposes, In the event diat there is a dispute on the
<br /> 3mount of the jpb cos� the City may request the submission of a signed copy of the actual contract.
<br /> ■ �'�Thc STATE SURCHARGE is .000� of the canuact price under$],000,004 or$5.00—whichever is
<br /> greater. For valuations over$1,000,000 call the Building 17epartment at(952)?49-4600 for the price.
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<br /> The undersigned hereby applies to the City for issuance of a Plumbing 1'ermit, agrees to do all
<br /> wark in strict accordance with the ordinances of the City and the regulations af the State of
<br /> Minnesota, and certifies that all statements made on this �pplication are complete, true and
<br /> correct.
<br /> Applicant's Signature: Aat�: ��- 1� -��
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<br /> ��.R�es�t,';F�o'r,>m��,
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