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10/13/2014 13:2a F�� 9529335049 CULLIGAN ViNTKA �004 <br /> � <br /> ,,; tl '��x:�%���E�;�Ait�r���i�r�CS"�=:ioBs-Q���`�$�oo'.00 ,, .., <br /> If above does not apply;follow guidelines below: <br /> 1. CON'f�ACT PRiCF "`is 1.25°/a of contraet priCc with a(M�nimum Fee of$50.00) <br /> x_0125$ <br /> (conffacT price) (minimum$50.D0) <br /> 2. STATE SUTtC�ARGE *�Add the 5tate Bldg Code Div. Surcharge(Minimum Fcc of�5.00) <br /> x .0005 � <br /> (conirRcl pricc) (Ininimum$ S,OQ) <br /> 3. PpS7'AGE&HANp�,1NG(Only on Mail-Cn Applications} $ 2.00 <br /> 4. TOTAl.PER1viIT FEE(Add Lines L-3 Above) � ��. �� <br /> ■ * CO:VTRAC7 PRICE or J013 C05T mcans the actual or estimated dollar amount charged for the <br /> permitted work including materials,labor,profit, and other fixed costs. ft is the amount to be char�ed <br /> i0 the customer for the wprk dona If any material,cquipmen[, labor or installtltions are furnished by <br /> the owner,tcnant or�ny other party, the reasonabie market value of sach items must be added to tJie <br /> cstimated cost or con�raet price for permit fcc purposes. In the event that there is a dispute on the <br /> amount of the job cost, the Ciry may request the submission oF a signed eopy of the aetuaI contract. <br /> ■ *'�The STATE SUTtC1�lARGE is.0605 ofthe contract prioe under�1,000,000 or�5.00,whichevcr is <br /> �areater, FoC valuations ov�r F 1;000,000 caI]the Bvilding Dcpartment at(952)249-4600 for the price. <br /> r�ll jh I,�PI����"6��� lj��� 'I�p�����3u�1'��������iJ,".Y'lr'I%`L�^Ir•,.�,��.� �15�;�' �� �9'�Y��. ��)�n��.�'1!`� `i`�� ��� <br /> 1,. q�.�V '�� M( II�a,d.�W i !V� rA.i .d��'1��Y.er� <br /> The undersigned hereb}� applies to the City for issuance of a Ptumbing permit, �,grees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesot� and certifies that al] statements made on this application are complete, true and <br /> correct. <br /> Applicant's Signature: Date:�- �.�- �� <br /> ���°n������,��n'�g <br /> �;��;�Yho��,n.�iti�^=„�atw�,r.�>����'� <br /> i <br /> 3 <br />