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'09/2'2/2016 08:10 FAX 952�Jaa5049 CULLIGAN A�NTRA �00�
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<br /> FIXTURE BSMT 1sT 2"0 07HER FIXTURE BSMT 15T 2"° OTHER
<br /> TYPE Floor Floor TYPE Floor Floor
<br /> Water Cioset Floor Prains
<br /> Lavatory Sewer Ejector
<br /> Bathtub Laundry Tray
<br /> Shower Washer
<br /> Kitchen Sink Water Heater
<br /> Disposal Water SoftenEr
<br /> Dishwasher �Net Bar
<br /> Sillco�ks Miscellanevus
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<br /> 1. CONTRAC7 PRICE * is 1.25% of contra�t price with a (Minimum Fee of$50.00)
<br /> x .D125 $
<br /> (contr�ct price) (minimum $50.00)
<br /> 2. STATE SURCHARGE
<br /> x .0005 $
<br /> (contract price)
<br /> 3. POSTAGE � HANbLING (Only on Mail�ln Applications) $ 2.00
<br /> 4. TOTAL PERMIT F�� (Add Lines 1-3 Above) $ � • a �
<br /> * CQNTRACT PRICE or JOB COST means the �ctual or �stimated dollar amount charged for the
<br /> permitted work including m�terials, labor, profit, and other fixed costs. lt is the amount to be charged to
<br /> the customer for the work done, ff any material, equipment, labor or installations are furnished by the
<br /> owner, tenant or any other party, the reasonable market value of such items must be added ta 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 cast, the City may raquest the submission of � signed copy of the actual contract.
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<br /> The undersigned hereby applies ta the City for issuance of a Plumbing Permit, agrees to do all work in
<br /> strict accordance with the ordinances of the City and the regulations of the State of Minnesot�, and
<br /> ��rtifies th�t a11 statements made on this application are complete, true and correct.
<br /> ApplicanYsSignature: Date: �'a� - �b
<br /> Building Official/ Inspector: Date:
<br /> Page 2
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