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`w <br /> • � , , <br /> PLUM�ING FIXi.URES BEING 1NSTALLED ' <br /> FIXTUP,E BSMT 1sT 2ND OTHEP. FIXTURE BSMT 1S' ZND OTHER <br /> TYPE Floor Floor TYPE Floor Floor <br /> Water Closet � Floor Drains <br /> i <br /> Lavatory Sewer Ejector <br /> � � <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater I <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> I <br /> Sillcocks Miscellaneous I <br /> PEP.MIT FEE CALCULATION <br /> 1. CO���,��C i '�lC� * is 1.25% oi contract price with a {i�len3mu;:� �e� oi���.OJ) <br /> x .0125 $ �D • DO <br /> (contract price) (minimum $50.00) <br /> 2, S s�T� S��'��T,nG�' <br /> x .0005 $ �' � � <br /> (coniract price) <br /> 3. rflS i�G� � NA�1�Ll�li� (Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL i�=R��117 F�� (Add Lines 1�3 Above) $ � �3 ' � � <br /> * rp��i RArT PR�CE nr JOB CnST .m..ear,s thA �ct��al �r estimat�d dc�ll:r amount charged fcr the <br /> permitted work including materials, labor, profit, and other fixed costs. It is the amount to be charged to <br /> the customer for ihe work done. If any material, equipment, labor or installations are furnished by the <br /> owner, tenant or any other party, the reasonable market value oi such items must b`e added to the <br /> estimated cost or contract price for permit fee purposes. In the event that there is � dispute on the <br /> amouni of the job cost, the City may request the submission of a signed copy cf the-actaal contract�. <br /> PLUMBiNG PERMIT APPLICATION AGREEMENT <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 regulat.ir.�s of the State of Minnesota, and <br /> cer�ifies that all statements made o 's applicatio are complete, true and c�rrect. <br /> ���� <br /> Applicant's Signature; Date: IZ I�� �b <br /> ,.� , <br /> Building Oiiicial/ Inspector: Da�e: <br /> Page 2 <br />