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08/26/2013 12:06 FA� 9529335049 CULLIGAN MNTKA [�004 � P�x�z�r��c�:cu�,��rtorr s ,�:ro�s�ov��soo:oo , .. < < , If above does not apply;follow guidelines below: 1. CONTRACT PR10E * is 1.25%of contract price with a(Minimum Fee of$50.00) x,0125$ (contraci price) (minimum$50.00) 2. STATE SiIRCHARGE **Add the State Bldg Code Div, Surcharge(Minimum Fee of�5.00) x.0005 $ (contract price) (minimum$ 5.60) 3. ?OSTAGE&HANDLING(Only on Mail-In Applications) $ Z,pp 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ aa, Q(� ■ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted work including materials, labor, profit,and other fixed costs. It is the amount to be charged to the customer for the work done. If any material, equipment, [abor or installations are furnished by the owner,tenant or any other parry,the reasonable market value of such items must be added to the estimated cost or contract price for permit fee purposes. In the event that there is a dispute on the amount of the job cost, the Ciry may requast the submission of a signed copy of the actual contract, � **The STATE SURCHARGE is.0005 of the contract price under$1,000,000 or$5.00—whichever is greater. For valuations over$1,000,000 call the Building Department at(952)249-4600 for the price. l�y�ti.'It,� r.a4�� Ci..W`fl)�hi 1 .._ �� y—r 4!'p�i,'�'�� ;p��,t, ;C7 4�t�1ts � t, �<r't ��ii.^�.' f �'�i.?'?,it.l+ i. 3 ' 1`. r �,'�?�W'_ .�S].�.' _LI�Y,�'G��,� "'' x ;,�i%�. .t The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do al] work in strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements made on this application are complete, true and correct. Applicant's Signature: � Date: $-a�,- 1 Reset Form 3