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05/09%201� 09:a� FA� 9529�35049 CULLIGAV MNTKA �004 <br /> r r�.,��,.,�. �ti� ;�: � ,� y� � �� '�' '''i, <br /> .,r� �'��},�.�'� '�`P���'�� �!'�`. ' �f;L:'�"�'�Tx�1�, S ''=��,OB;S'.C1��V`�7t,$�(?O;OQ �� ;�,r,k�;:`- 7: <br /> If abovc does not apply;follow guidclines below: <br /> 1. CONTRACT PRICE "'is 1.25°/a of contract price with a(:V15nimun�Fee of�50.00) <br /> x.D125$ <br /> (eon[racr pncc) (minimum$50.�0} <br /> 2. STA'I'E SURC�TA�(Y� *'�Add the State Bldg Codc Div.Surcharge(Minimum Fee of$5.00) <br /> x.0005 $ <br /> (contractprice) (minimumR 5.00) <br /> 3. POSTAGE&HANDLII�iG(Only on Mail-In Applications) $ _ ?-00 <br /> 4. TOTAY�1'�RMIT F'EE(Add Lines 1-3 Abovc) $ ��� �-S <br /> ■ * COZ�''fR4CT PRICE or JOB COSI" means tho setu�l or estimated dollar amount charged for tBe <br /> permitted work including materials, labor,profit,and other fixed costs. It is the amount to be charged <br /> to thc cuslomer for the work done. If any m2terial, equipmcnt, labor or installations are fumished by <br /> thc owner,tenant or any other party, the reasonabla market value of such itcros must be added to thc <br /> e5timzted cost or contraet priee for permit fec purposes. In the event th?�C Chere is a dispute on Yhe <br /> amount of the job cost,the City may rcquest the submission of a signed copy of thc actusl eontract. <br /> � '�*The STATE SLRCHARGE is.0005 of the contraet price under$1,000,000 or$>A�—whichevcr is <br /> gre0.ter. Por valuations ovcr$1,000,000 call the Building�epartrnent at(9�2)249-4600 for the priee. <br /> �':BIl�1��6�dN��.����p� �l199�^� A� � i 4 �I � H (r. i 5' a ,�i�i����1�jw�'f�i�i"�^�ii'�I:���'��"i�f' <br /> ;f4� r�+� � ,�1 � �„rzAi,9�'PT�;T711�'BB,TI'�1'�, �R�'T�P�'LXG`�`�4�`�bI*I�SA,G1����`�'� ,�, „c�-,:��,����_.�l.�, <br /> The undersigned hereby applies to the C�ty for issuance of a Plumbing Permit, agrees to do all <br /> wprk in strict accordance with the ordinances of the City and the regulations of the 8tate af <br /> '.1�tinnesota, and certifies that aIl statements made on this application are complete, true and <br /> CORect. <br /> Applicant's Signature: Date: .J-� " ��v <br /> ��� � : <br /> Res��Form <br /> ,v , .... :�.: <br /> 3 <br />