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04/19/2016 10:a2 FAX 952flaa5049 CULLIGAN MNTKA C�007
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<br /> If above does not apply;follow guidelines bclow: 1
<br /> 1. CONTRACT PR�CC *is 1.25%o�contract price with a(Minimum Fee of�50.00) _ �'V
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<br /> x.o�as$
<br /> {con[rsa pncc) (minimum$SO.DO)
<br /> 2. STAT�SYITtCHARGE **Add the SCate 13Idg Code Div. 5urcharge(Minimum Fec ofS5.00)^ ./'
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<br /> x.0005 $ � �
<br /> (contrnc[priCe) (minimum$ 5.00) �
<br /> 3, POSrAGE&HANL]LING(Only on Mail-In Applications} $ 2.00 �
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<br /> 4. TOTAL P�RMIT FEE(Add Lines 1•3 Above} $ �
<br /> ■ " CONTRACT PRICE or J0� COST means the actual or estimated dollat amount charged for the
<br /> perm�tted work including matcrials, IAbor,profit,and other fiaed eosts. [t is the amount to be chargcd
<br /> to tho customer for the work done, if any material, equipment, l�bor or installations are furnished by
<br /> the owner,tenant or any other party,the teasonable market value of such items must be added to the
<br /> estimated cost or contract pricc for permit fe� purposes. In thc event that therc is a dispute on thc
<br /> amount of the job cost,thc Ciry may requcst the submission or a si�ned copy o'C She Actual contraeC.
<br /> • x*The STATE SURCHARCrE is.0005 of the contract priee under$1,000,0�0 or$5.00 T whichevei'is
<br /> greater. For valustions over$1,000,000 call the Building Department 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 aeeord�nce with the ordinances of the City and the regulations of the State of
<br /> Mins�esota, and eertifies that all statements madc on this application are complete, true And
<br /> correct.
<br /> AppIicant's Signature: Date: � �' U�
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<br /> R�set For�,,
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