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O1/19/2015 1a:22 FAT 9529a35049 CULLIGAN MNTKA 1�004
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<br /> lf above does not apply;follow guidelines below�
<br /> �. CONT_RA,C'X'�'AZXC� "'is I.25%of contract price wizh a(Minimum Fee of$50.00)
<br /> x.O]25$
<br /> (concracc price} (minimum$50.00)
<br /> Z. STATE SURCHARGE �*Add the State Bldg Code 177iv.Surcharge(Nlinimum�ee of55.00)
<br /> x.0005 $
<br /> {contrnct price) (minimum S 5.60)
<br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.0�
<br /> 4� TOTAL PERMIT FEE(Add Lincs 1-3 Above) $ �a. ��
<br /> ■ x CONTRACT PWCE or ]OB COST means the actual or estimatcd doilar amount charged for the
<br /> pernllt[ed work including materiaIs,Iabor,profit,and other fixed costs. It is the amount to be charged
<br /> to the customer for the work done. [f any matcrial, equipment, fabor or installations are fvrnishcd by
<br /> the owner,tenant or any other party,the reasonable markct value of such items must be added to the
<br /> estim3ted cost or conttact price for permit �ee purposes. In Chc cvcnt that there is a dispute on [he
<br /> amount of the job cost, the City may request the submission of a signed copy of the actual contract.
<br /> � *�The STATE$URCHARCrE is.0005 of the contract pricc under$1,OOQU00 or$5.00—whichevtr is
<br /> groatcr. For valuations over$1,000,000 call the Building Deparhncnt at(952)249-4600 for the priec.
<br /> a�i.�..*.y'��9 .�,���� �'.a ��ri IS4�M� �F w i � y���,�y � T Y�c�r 4�,��1�.y� �� �. .��n .q.,,,�aj���.���)i�i��1�,'J,.wa:r'�r�
<br /> i:`+'4'�.VL4 u d.1.�-a��'�in�..x.n..�1�����J1r;l.�?��`��,�`��_�.LL,l�+7?'ll,.��. ?��)l� ���iJ.;ti'��a ,t�� ��. ;i"���';� �
<br /> The undersigned hereb� applies to the CIty for issuance of a Plumbing Permit, agrees to do all
<br /> work in st�-iet aeeordance with the ordinances of the Ciry and the regulations of the State of
<br /> Minnesot� and certifies that all statements made on this application are eomplete, true and
<br /> correct.
<br /> Applicant's Signature: Date: �._�
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