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[� PLUMBING FIXTURES BEING INSTALLED � <br /> FIXTURE BSMT 1sr 2ND pTHER FIXTURE BSMT 1sr 2ND pTNER <br /> TYPE Floor Floar TYPE Floor Floor <br /> Water Cioset �.� ,� ;� Fioor Drains � <br /> Lavatory � �� ,� Sewer Ejector � <br /> Bathtub ' � �aundry Tray <br /> Shower ;� '� Washer � � <br /> Kitchen Sink i Water Heater � <br /> � Disposal � Water Softener � <br /> Dishwasher 1 Wet Bar � <br /> Sillcocks � Miscellaneous <br /> PERMIT FEE CALCULATION � � <br /> 1. CONTRACT PRICE * is 1.25% of contract price with a (Minimum Fee of$50.U0) <br /> ����~), ��,7��f ���% x .0125 $ �� / ��i. �� <br /> ' (contract price) (minimum $50.00) <br /> 2. STATE SURCHARGE <br /> ' ��, �`� <br /> � �, ��;�',1� U�`i x .0005 $ <br /> (contract price) <br /> 3. POSTAGE 8� HANDLING {Only on Mal-in Applications} $ 2.00 ,�� <br /> �� �� � . <br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above} $ �j�� -�, �� �, '� <br /> : <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work including materials, labor, profit, and vther 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 furnished by the <br /> owner, tenant or any other party, the reasonable market value of such items must be added to the <br /> estimated cost or contract price for permit fee purposes. in the event #hat 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 contract. <br /> PLUMBING PERMIT APPLICATION AGREEMENT____ __ <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 regulatians of the State of Minnesota, and <br /> certifies that all statements made on this application are comple#e, true and correct. <br /> Applicant's Signature• ���✓����J ' . ��-�� Date: ����� �tli <br /> � <br /> Building Official/ Inspector: Date: <br /> Page 2 <br />