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09/11/2013 12:24 FAX 9529335049 CULLIGAN MNTKA �004 <br /> `PE�vII�FEE'.CAI,CTJL'��1TI�I�J S ;=J'OBS:;QV�,$50�:00 , ;: <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee oi$50.00) <br /> x .0125$ <br /> (contract price) (minimum$50,00) <br /> 2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(Minimum Fee of 55.00) <br /> _ x.00OS � <br /> (contract pnce) (minimum$ 5,00) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) � 2,00 <br /> 4. TOTAL PERMiT FEE(Add Lines 1-3 Above} � a a. o� <br /> � * CONTRAC"I' PRICE or JOS COST means the actual 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, [abor or installations are furnished by <br /> the owner,tenant or any other pazty,the reasonable market value of such items must ba added to the <br /> estimated cost or contract price for permit fee purposes. tn the event that thare is a dispute on the <br /> amount of the job cost, the City may request the submission of a signed copy of the actua[ contract. <br /> ■ **The STATE SURCHARGE is .0405 ofthe contract price under$1,OQ0,000 or$5.00—whichever is <br /> greater. For valuations over$1,000,000 cal]the Building Department at(952)249-4600 for the price. <br /> �;�'f+��Ht' cIi!M}'t4 21'� C 7�v ,�y� � t� ,�' y �d I i!�` n(SI � itV��.t^t�t(t�d;` j�: <br /> , . ' 1'il�Y'�.��.� ,. �� 'i P. <br /> ,,�t�,.�.F 5��.,����,�s,���_ ��'I.�T�_,� ��`� , P ������,�,�'R`��1uS� . : ��.�a L.�.��,� �G,.Y <br /> The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the State of <br /> ;vlinnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> lian 'sSi nature: ���.� � �- <br /> App c t g __ Z Date: I � � <br /> Reset �orm <br /> 3 <br />