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05/22/2014_11:29 FAX 9529�95049 CULLIGAN MNTKA f�004 <br /> � � ' <br /> ,.,.;-� ^, ,,;,, , ,-;':p��n�T�'��`�AI;C���A�Zo�tfS ,-JOBs?c��R;�Soo:oo ', , s�� <br /> If above does not apply;follow guideiines below: <br /> 1. .�( N�RACT PRICE *is 1.Z�%of contract price with a(Minimum Fe�of 550.00) <br /> x.0125� <br /> (con[rac�price) (minimum�50.00) <br /> 2. STATE SLII2C�ARGE **Add the State Cildg Code Div. Surcharge(Nlinimum�ee of S5.U0) <br /> x_0005 $ <br /> (wntrac[pricc) (minimum$ �,DQ) <br /> 3. POSTAGE&HAM7�.ING(Onty on Mail-In Applications) $ 2.0� <br /> 4. TQTAL P�i�MIT FEE(Add Lines 1-3 Above) $ . �(J <br /> ■ � CONTR�CT PRICE or 7Q� COST means the actual or estimated dollar amount char�ed for the <br /> pzrmitLed work including m�tcrials,labor,profit,and other fixcd costs. It is the amount to be charged <br /> to the customer for the work done. If any material,equipment, labor or inStallationS are fumished by <br /> the owner,tenznt o[any other party,the reasonable market value pf Such liems mvst be added to the <br /> estimated cost or contract price for permit fee purposes. In the cvcnt that there is a dispute on the <br /> araount of the job cos�the Ciry may requcst the submission of a signed copy of the aetual contract, <br /> ■ '""'The STATE SURCHARGE is.0005 of the Contr�►Ct price under$1,000,000 or�5.00—whichever is <br /> greAter. For valuations over�1,000,000 ca11 the Building Dcpamnent at(952)Z49-4600 for the priee. <br /> � .�' S. ,eLM�..��Yr��ry^T N� o �' �{�, ur �� b '.A�j"'I�1r' A� �('ryI ry��y� �1+ n�{� A 1 <br /> O4Ar l I�l6.Y .rY.,f;t�li IHUJ��Y'��:���A����`u ��:'tl'J.A,�"+1J.1';��h+.O,�����M+! ! f�nil`11d�d4} ���1�� y.��y��Y�.l <br /> ,� :"��,�,nl�, ���w�-,���r <br /> The undersigned hereby appIies to the City for issuance of a Plumbing Permit, agrees to do all <br /> work in strict aGCordance with the ordinances of the City and the regulations of the State of <br /> Minnesot� and certifies that �11 statements made on this application a�•e completc, true and <br /> correct. <br /> AppIicant's Signature: � Date� �S—c�� — I�� <br /> i����'�+,��M�� <br /> '.�t- �uar�c�.u���or1��:.i�v,i� <br /> I <br /> 3 I <br /> i <br />