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03/06/2013 13:15 FAX 9529335049 CULLIGAN MNTKA C�004 <br /> � '� <br /> � � <br /> �r i ,�..: ,,. <br /> �'��,tt:•r,.•x�r;;� „%�� 1'.��, .,�..���'���: "��.�{��, � '�� �'" :�RJ�Q'��,k' ��',�:;;:, :"<.�' <br /> ,.�:;a..,, <br /> ' i <br /> Tf above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of 550.00) <br /> 1 <br /> I X.a�25$ <br /> (contract pnce) (minimum 550.00) <br /> t <br /> 2. STATE SURCHARGE **Add the State Bldg C�de Div.Surcharge(Minimum Fee of 55.00) <br /> x.0005 $ <br /> (contract price) (minimum S 5.00) <br /> 3. POSTAGE&HANDLING(Only on Mail-in Applications) $ 2.00 <br /> i <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) S d�.a� � <br /> � __ _ . _ __... . _ _ .. - - <br /> ■ * CONTRACT PR10E or JOB COST means the actuaf or estimated dollar amount charged for the <br /> permitted work including materials, labor,profit,and other fixed costs. It is the amount to be charged <br /> . to the customer for the work done. if any material, equipment, fabor or installations are furnished by <br /> the owner,tenant or any other party, the reasonable market value of such items must be added to tha <br /> estimated cost ot contract price for permit fee purposes. 1n the event that there is a dispute on the <br /> , amount of the job cost, the City may request the submission of a signed copy of the actual contract. <br /> ■ **The STATE SURCHARGE is.0005 of the contract price under$1,OOQ,000 or$5.00-whichever is <br /> greater. For valuations over$1,000,000 call the Building Department at(952)249-46�0 for the price. <br /> � � ,� ; i . r, <br /> .! ,�� . � � . ,'�.� '�� � t,3_: �, + �- � � <br /> The undersigned hereby applies to the City for issuance of a Alumbing Permit, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regvlations of the State of <br /> Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> pplicanYs Signature: Date: .3 - L-. � <br /> r � <br /> �� t ' ' � <br /> t�a 'r,C,3:'�%�,'�G,i5 d�;!�� <br /> 1 <br /> 3 <br />