Laserfiche WebLink
05l10l2016 12:49 �AR} P.OQ3lQ03 <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE SSMl� 1 T 2 ° OTHER FIXTURE BSMT 1sr ZND p7'y�R <br /> �'YPE Floor Floor TYPE Flaor Floar <br /> Water Gloset Flaor Drains <br /> I�avatory Sewer EJector <br /> Bathtub Laundry Tray <br /> Shower Wpsher <br /> Kltchen S)nk Water f-ieater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> SiIIcOCks Miscellaneous <br /> PERMIT FEE CALCULATION <br /> 1. CdNTRACT PRICE " is 1.25% of contract price with a (Minlmum �ee of$b0.00) <br /> x .0125 $ <br /> (contract price) (minimum $50.00) <br /> 2. STATE SURCHARGE <br /> x.0005 $ <br /> (contract price) <br /> 3. POSTAGE & HANDLING (Only on Mail-In Applications) $„ , 2.OQ. _._ <br /> 4. TOTAL PERMIT FE� (Add Lines 1-3 Above) $ � �'4� <br /> x CONTRACT PRIC� or JOB COST means the actual or estEmated dollar amount charged for the <br /> permitted work including materials, labor, profit, and other fixed costs. !t is the amount to be charged to <br /> the customer for the wotk dane. If any material, equipment, labor or installations are furnished by the <br /> owner, tenant or any other p�rky, the reasonable market valus of such item5 must be added to the <br /> estimated cost or contract price for perrr�it fee purp�se&_ 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 actual cpntract. <br /> PLUMBING PERMIT AI'PLICATIQN AGREEMENT <br /> The undersigned hereby applies to the City for lssuance of a Plumbing Permit, agrees to do all work in <br /> atrict accordance with the ordinances of the Clty and the regulatlons of the State of Minnesota, and <br /> cert(fies that all statements made on this appficatlon are complete,true and correct. <br /> ApplicanYs Signature:_l�U�� , C.�1iv�-� Date: ��� lro <br /> Building Official/Inspector: Date: <br /> PAqe 2 <br />