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06/27/201� 08:�7 FAX �529��5049 CtiLLIG�N M�TKA C�00�
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<br /> FIXTURE BSMT 1s' 2"o OTHER FIXTURE BSMT 1sr 2ND �jHE�
<br /> TYPE Floor Floor 1YPE Floor Fivor
<br /> Water Cfoset Floor Drains
<br /> �av�tory S2wer Ejector
<br /> Bathtub Laundry Tray
<br /> Shower Washer
<br /> KitChen Sink Water Heater
<br /> Disposal Water Softener 1
<br /> Dishwasher Wet Bar
<br /> Sillcocks M iscel[aneous
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<br /> 1. CONTRACT PRICE " is 1.25% of contract price with a (Minimum �ee of�50.00)
<br /> x.0125 $
<br /> (cantract price) (minimum �50.00)
<br /> 2. STATE SURCHARG�
<br /> x .OQ05 �
<br /> (contract price)
<br /> 3. F'OSTAGE � HANDLlNG (Only on Mail-In Applications) $ 2.00
<br /> 4. TOTAL PERMIT FE� (Add �ines 1-3 Above) �__ 5_a� ��
<br /> " CONTRf�1CT PRICE or JOB COST means the actual or estimated dollar amount charged fior the
<br /> permit�ed work including materials, labor, profit, and other frxed costs_ It is the amount to be charged to
<br /> the customer for the work done. If any material, equipment, labor or installati4ns are furnished by the
<br /> owner, tenant or any other party, the reasonable market v�lue of SUCh items must be added to the
<br /> estimated cost or contract price for permit fee purposes. In.the event that there is a dispute on fihe
<br /> amount of the job cvst, the City may request the submission of a signed copy of the actual contract.
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<br /> �'�`ytl tili wy�1��.�;�.���.'1�;4L��," ..'!. � I�� . I, R�I �� �n. �,�����,�.�� ..� I... .����II;IHy�i�i�rm���la����ll'���uilyld�Uh��vpUi�4l�iirvu II{
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<br /> Yhe undersigned hereby �pplies fo the City for issuance of a Plumbing Permit, agrees to do all work in
<br /> strict a�cordance with the ordinances of the City and the regulations of the State of Minnesota, and
<br /> certifies that all statements m�de on this application are complete, firue and correct.
<br /> ApplicanYs Signature: Date: �.� ��1� l�o
<br /> Building Official/ Inspector: Date:
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