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10/23/2012 13:13 FAX 9529335049 CULLIGAN MNTKA f�004 <br /> I „�,. . r (�,��'_1 , ,(�►x�.['! ( �`1 /'� 7�{} .. r.S�.. •!i' <br /> ��I �'�+1r+°,f�,r.i..l 6' : }�i .i.:��1. .�, , ,�'�.G�rll::J11,����WLry,'i'� fihr�?'i�,J;l'1�����.V��, 2���-N ..�...M` ".{ <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE * is 1.25%of contract ptice with a(Minimum Fee of$50.00) <br /> x.0125 $ <br /> (conaact price) (minimum$50.00) <br /> 2. STATE SURCHARGE **Add t6e State Bldg Code Div. Surcharge(Minimum Fee oFS5.00) <br /> x .0005 $ <br /> (contrac[price) (minimum S 5.00) <br /> ! 3. POSTAGE&HANDLING(Only on Mail-in Applications) $ 2.00 <br /> � 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ao�•d U <br /> ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work including materials, labor,profit,and other fixed costs. 1t is the amount to be charged <br /> to the customer for the work done, if any material, equipment, labor or installations are fumished by <br /> the 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 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 contract, <br /> ■ '�* The STATE SURCHARGE is.0005 of the contract price under$1,000,000 or$5.00—whichever is <br /> greater. For valuations over$1,000,000 call the Building Deparhnent at(952)249-4600 for the price. <br /> � - <br /> u �' � u r �; s. 7 y :t <br /> The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the �tate of <br /> Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> Applicant's Signature: �� Date: � - ,3- � <br /> �k., •is, . „�;;k:� <br /> 3 <br />