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a� '� 171P +„� . <br /> J a - � nkm� <br /> i <br /> FIXTURE BSMT 137 2ND bTHER �IXTURE BSMT �sr 2No QTf..��� <br /> TYPE �lapr Floor TYP� Floor Floar <br /> � <br /> Watar Closet � Floor Drains <br /> Lavatary � Sewer Ejector <br /> Bathtub L�undry Tray <br /> Shower ' , Washer <br /> Kitchen Sink � Water Heater <br /> Dlsposa) Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellanepus <br /> , . <br /> .da~ "�. ��� � � I.J �� <br /> 1. CONTf�ACT PRlCE '" is 1.25% of contract price with a (Minimum �ee of$50.00} <br /> c�a, U C� x .0125 $_ _ �.Z;Z..,5�� <br /> (contract price) (minimum $50.00) <br /> 2. STATE SURCHARGE <br /> �� o � . �o � .oao5 $ y ., �� <br /> (contract price) <br /> 3. PQSTAGE 8 HANDLING (Only on Mail-In Applications) $ <br /> A�. TOTAL PERMiT F�E (Add Lines ��3 Above) $ /� �� �� <br /> � CONTRACT PRIC� or JOB CQST means th� actual or estimated dollar amount charged for the <br /> permitted work including materials, labor, profit, and other fixed costs. It is the amount to be ch�rged to <br /> the Customer for the work done. ff any m�teri�l, equipment, (abor or installations �re furnished by the <br /> owner, tenant or any other party, the reason�ble market value of such it�ms must be added to the <br /> estimated cost or contract price for permit fee purposes. In khe event that there is a tlispute on the <br /> amaunt of the job cpst, the City may request the submission of a signed eopy 4f the actual contract, <br /> � , � - MJ��������. ' - `� ~ <br /> v <br /> The undersigned hereby applies to the City for issuance ofi a Plumbing Permit, agrees to do all work in <br /> strict accord�nce with the ordinances of the City �nd the regulations of the State of Minnesota, and <br /> certifies that all statements made on this application are comp(ete, true and correct. <br /> App(icanYs Signature: � Date� ������ <br /> Building Official/ Inspector: Date: <br /> Pagc 2 <br />