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01i14i94 17:04 71� CITY OF OR17NQ 612-4?3-?357 003 <br /> PE�,'�' I+`EE �U �'�I�N <br /> �. 1.,�� Of[�'nntr.Lrt Frir-r.'�' t1t M1111111111I1 �'P,t: f�:�.Q�� <br /> '����� — x .O12S $ �`�� .�-�� <br /> (cornracc ptyCe) <br /> 2. Stat,e 3�rcr I�aree• *"' Add the State Buildit� Codc ltiivisi�t <br /> � Surcnarge W each per�nit. x .t�5 $ ���5 <br /> {onntraci price) <br /> or $.5(}, whichever is gre�ter <br /> 3. P��ar�d Handlin� (th�ty mait-in a�plica�tians) � 1.50 - <br /> 4. �'OTAL PERMiT FEE (Add Iiz�s 1-3 ahnvc) $ _,�7, ?�-_� <br /> * CON'TRACT PRICE Or 1U�G17ST nuans tbe acxual or ratimaied dotla��maunc charged far thc gcrntivad <br /> � worlc including materiala� labor� F�+a�c, and cNher �ixesi costs. It ia ths �►nwunt to be chArged to tht <br /> customer fdT the virork done. If any maEe�is1. exiu�p�tieat,labor,or ins[allation are fumiahcd by the owner� <br /> tennne or any oeher�rty �he reasonable ma�ec valuo vI such itema must bc addat eo the cati�tad eat <br /> t�r cancracc prtee for permit fee pwrpwr.�. In tho event thae cherc is a ditpute on thc amount nf the Job oost, <br /> the City may request il�c submiasion af a aggncd oopy of the accue3 aontrsct• <br /> '�" 't71t STATS SURCHARGE is .UDOS ai ttle contract pci�x u�;dtr SI,a0Q,000 or S.SO - whicLcvcr ta <br /> greacec. For valusuions ovar 52,000�000 call t�a Ikpmrcmc�t of iuspectional Sc:vices for tha prisx. <br /> Tl7e undersigt�d hereby apglies tt� the City for issuance of a Plvmbing Perrnit, agrr.�s ta do alI <br /> work in StriCt accorda�vice with the ordinances of the City and d�e rcgulatians of thc Stata of <br /> Minnesot�, 2►nd certifies �,at 2t1( sta�tements made c�n th�s applicat�o� are eomplete, txue and <br /> corr�ci. <br /> � <br /> A�Plicam's Signatur+t: U'��•_���� �� ��� Date; — I '7 -��- <br />