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06/2�%2015._14:0� FA� �52�a�504� CULLIGA� MNTK� C�004
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<br /> , . If above does not apply;follow guidelines below: s •
<br /> 1. CONTRA,CT P�r�� *is 1.25°�0 of contract price with a(1VIinitnum Fee of 550.00)
<br /> x.0125$
<br /> (�onmau price) (minimum��O,00}
<br /> 2. STAT�SURCH.ARG� **/�dd U1e STate�idg Codc Div. 5urcharg�(Minimum Fce of 55.00)
<br /> x .0005 $
<br /> (conasc[price) (minimum� 5.00)
<br /> 3. POSTAGE&HANb�,7]�1G(Only on Maal-In Applications) � 2_00 _
<br /> 4. TO'�'AT�PER�F'IjT FEE(Add Lincs 1-3 Above) $ a-�-��
<br /> ■ * CONTRACT PRICE or 30B COST means the actual or estimated dollar Amount charged foC ihe
<br /> permitted worlc including materials, labor,proft,and other fixed coSSs. It is the amount to be charged
<br /> to Lhe customer for the work done. If any m�terial, equipment, labor or installations are fumishcd by
<br /> the owner,tcnant or any other party, the reasonab]e market�alue of such items must be addcd to ihe
<br /> estimated cos[ or contract pricc for pe�rnit fee purposes. Yn the event thst there is a dispute on the
<br /> amount of the job cos�thc City may request the submission of a signed copy of tho aetual contract.
<br /> � �**The S7'A7'E SURCHARGr�is_0005 of the contract pricc undet$1,000,000 or$5.00—whichever is
<br /> greater. For valuations over 51,000,000 eall the�uilding Department at(952)249-4600 for the,pricc.
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<br /> ,?��,�����,A>,".�pr�,rd,��,��;'.,fz�?'�'F��� ! �i�'��'P�APPLIG�,��; 'Ca��.�GREEN'1�N�t:,.,-,�wa;� ��,��.�, ,,��-.
<br /> The undersigned hereby applies to the City for issuance of a Plumbing Pennit, agrees to do all
<br /> work in strict accordance with the ordinances of the City and the regu]Ations of the Siate of
<br /> Minnesota, and cenifies that a11 statements made on this application are complete, true and
<br /> correct.
<br /> Applicant's Signature: - pate: �b - �-� - f
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<br /> I���S.��r1'FO'fRl�
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