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10/17!2011 13:19 FAX 9529335049 CULLIGAN MNTKA �J004 <br /> ; , . <br /> .PE�viIT` ;C�1�.Ci�:�;t�'�'IOA1:`.S -�:JOBS.O�JER:$�U:0:00' <br /> [f above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE * is 1,25%of contract price with a(Minimum Fee of$50.00) <br /> x.0125$ <br /> (contract price) (minimum 350.00) <br /> 2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(Minimum Fee of 55.00) <br /> x.0005 $ <br /> (contract price) (minimum$ 5,00) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �c�. U V <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. tt is the amount to be charged <br /> to the customer for the work done. if any material, equipment, labor or installations are furnished by <br /> the owner,tenant or any oti�er 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 Ciry may request the submission of a signed copy of the actual contract, <br /> ■ *"`The STATE SURCHARGE is,0005 of the contract price under$],000,000 or$5.00-whichever is <br /> greater. For valuations over$1,000,000 call the Building Deparhnent at(952)249-4600 for the price. <br /> �K',}: �+��ST'�hix�i..�:��`lt�� .�` S � �v�: I .� .t. ��_.,,7,.;IS,. ;�" G 'i;,��..:5:' '�.'jh`�iW7'if',''1�:7�f'? <br /> L'i,t� � <br /> The undersigned heraby applies to the City for issuance of a Plumbing Permit, agrees to do al! <br /> work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> Applicant's Signature: �c� Date: �d � 17 - j � <br /> � ��.��iihi�'t��; m� -� <br /> uRese��`�,q�rk�i� <br /> .,:�,:��,r�.��,-N��.�..:.�..,��:.�,�„� <br /> 3 <br /> I � <br /> i <br />