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08/11/2014 14:01 FA1 �52�a�5049 CULLIGAN MNTKA �004
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<br /> "'`� ,�: ,P�' 1�iL�U� ''TION S'"'`JO$S"C4 ,,�,; ,;� „•. ;
<br /> �.��`i$��0.0':0"0`� �.,,;'��';
<br /> 1f ebove does not appl�;follow guidclines below;
<br /> 1. C N�'RACT P CE *is 1?5%of contract�rice wish a(Minimum Fee of$50,00)
<br /> x.0125$
<br /> (contract pncc) (minimum$50.00}
<br /> ?. STATE Sl7RCHARG� 'y*Add the State Bldg Code Gliv.Surcharge(Mioimum P'ec of$5.U0)
<br /> x .00DS $
<br /> (canQacl UfIC2) (minimullt$ SAO)
<br /> 3. POSTAGE&�ANDLING{Only on Mail-�q Applicalions) $ 2.OQ
<br /> 4. TOTAI,PERMIT F��(Add Lines 1-3 Above) �_ �a, Q�
<br /> ■ � COI�'T}7ACT PRICE or JOB COST meens the actual or estimated do(lor amount charged for the
<br /> permitCed work including ma2erials,labor,profit, and otf�er fixed costs. It is the amount to be charged
<br /> to the customer for the work done. lf any material, equipment, labor or installations are fiimished by
<br /> thc owner,tenant or any other party,Uie reasonable market valuc of such items must be added to the
<br /> estimated cost or contract price for permit fee purposes. 1n the event that there is a dispute on the
<br /> amount of the job cost, tho Ciry may request the submission of a signed copy of the actual connac�.
<br /> ■ **The STAT�SURCHA}tG�is.0005 of the contract price undcr$1,000,000 or$5.00—wkliGhevcr is
<br /> greatcr. �'or valuations over$I,OOO,ODp call the Buildin�Department at(952)249-4600 for the priec.
<br /> ��,�i�1�lq'1. S�il�;ill�pl''�a�'1,���'.T�4�J6F�'.C'i� ',���::,�'1l' "a:C,� � .1.. r�F'�r�l•l1'��.'����. �r �V,4Ai^�VL'�' �,1�"r�';�I��u�4�{.{, 1 �`J�k'iY�� j+�}�f�Nt,,Py✓�}�{I��1,
<br /> ���iM I4NI4�ri i1.^IIY,1
<br /> The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do al]
<br /> work in strict accordanee with the ordinances of the City and the regulations of the State of
<br /> Minnesota, and ceriifics that 111 statements made on this application are complete, true and
<br /> Correct.
<br /> AppIicant's Signature: Date: - �
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