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11/2a/2016 09:05 FAX 95293a5049 CULLIGAN MnTKA �00�
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<br /> FIXTURE BSMT �sT 2ND pT�.{ER �IXTURE BSMT 1sT 2N° OTH�R
<br /> TYPE Floar Floor NP� Floor Floor
<br /> Water Closet Floor Drains
<br /> Lavatory 5ewer�jector
<br /> Bathtub Laundry Tray
<br /> Shower Washer
<br /> Kitchen Sink Water Heater
<br /> pisposal Water Soffener
<br /> Dishwasher Wet�ar
<br /> Sillcocks Miscellaneous
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<br /> 1. CONTRACT PR�GE �is 1.25% of contract price with a (Minimum Fee of$50.00)
<br /> x .0125 $
<br /> (contract price) (minimum �50.00)
<br /> 2. STATE SURCHARGE
<br /> x .0005 �
<br /> (cantract price)
<br /> 3, pQSTAGE & HANDLING (Only on Mail-In Applicatians) $ 2.00
<br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $
<br /> * CONTRAC7 PR10E or JOB COST means the actual or estimated dollar amount charged for the
<br /> permitted work including materials, labor, profit, �nd other fixed costs. It is the amount fio be charged to
<br /> the customer f�r the work done. lf any material, equipment, Iabor or installations are furnished by the
<br /> 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 purpQses. In,the event that �here is a dispute on th�
<br /> amount of the job cost, the City may tequest the submission of � signed copy of the actual contr2Ct_
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<br /> The undersigned hereby applies to 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 4f the State of Minnesota, and
<br /> certifi�s fhat all statements made on this app[ication are complete, true and correCt.
<br /> Applicant's Signature: � Date: ��` �3" �
<br /> Building Official/[nspeCtor: Date:
<br /> Page 2
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