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Jun O1 2016 2: 48PM HP LASERJET FRX p. 6 <br /> ' � . � I <br /> � ,l i � <br /> . . u � <br /> FIXTURE BSMT 1sT 2"� ' OTHER ' FIXTURE B�b� �sr 2ND OTHER <br /> TYPE Floor Flaar TYPE cRqw1. Floor Floo�r <br /> S�Au� <br /> Water Closet Z 3 I <br /> z 3 Floor Drains 'I <br /> Lavatory 3 � � Sewer Ejecior � <br /> Baihtub j �( Laurxiry Tray ( ' <br /> Shower � Z Washer <br /> Y I <br /> Kiichen Sink 2„ Water Heater ' <br /> � I <br /> Disposal � Waier Softener j I <br /> Dishwasher � Wet Bar � <br /> Sillcocks Miscellaneous ' <br /> !. <br /> � <br /> 1. CONTRACT PRICE "" is 9.25°�of contra�t price wi#h a (Minlmum Fee of$50.00yl <br /> '7�rYv— ._x .o,2s $ g.sr. 7..sr' <br /> (contract price� (minimum $50.Q0) <br /> 2. STATE SURCHARGE <br /> �� �Y° � X .000s $ 38.07 ''� <br /> (contract pnce) , <br /> 3. POSTAGE 8 HANDUNG (Only on Mail-In Applicationsj � Z.pp II, <br /> 4. TOTAL PERM�T FEE (Add Lines 1-3 Above) $ lq t' S Z I <br /> * C�NTRACT PRICE or JOB COST means the actual or estimated dollar amount char�ed for the <br /> permitted work including materials, labor, profit, and other fixed costs. It is the amount to be charged to <br /> the customer for the work done. If any material, equipment, labor or installations are furnis�ed by the <br /> owner, tenant or any other party, the reasonable market value af such items must be ad' ed to the <br /> estimated cost or cantract price for permit fee purposes. In 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 actU I contract. <br /> ,�, � � �. <br /> IF <br /> The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do',all work in <br /> strict accordance with the ordinances of the City and the regulations of the State of Minn�sota, and <br /> certifies that all statements made s appli a 'on are mplete, true and correct. ', <br /> Applicant's Signature: Date: �' '� I <br /> Building Official! Inspector: Date: ' <br /> Page 2 I <br /> i <br /> � <br /> � <br />