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10/24/2011 13:28 FAX 9529335049 CULLIGAN MNTRA f�004 <br />�� � _ <br /> ::��E-, - -P��i�:e���'r�o �;�. ���Ja �s�dv��5.4�:om:: :r� . - . <br /> If above does not apply;follow guidelines below; <br /> 1. CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of 550.00) <br /> x.0125$ <br /> (contract price) (minimum$50,00) <br /> 2. STATE SURC�A_RGE *'`Add the State Bldg Code Div. Succhsrge(Minimom Fee of S5.00) <br /> x.0005 $ <br /> (wntrnct price) (minimum S 5,00) <br /> 3. POSTAGE&HANDGING(Only on Mail-In Applications) $ Z•00 <br /> , . _ _ A. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ aa .�� <br /> ■ "` GONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> pem�itted work including materials, labor,profit,and other fixed costs. lt is the amount to be charged <br /> to the customer for the work done. If any matcrial,equipmcnt, Isbor or installations are fumished by <br /> the owner,tenant or arry other party,the reasonable market value of suc6 items must be added to the <br /> ostimated cost or comract price for permit fee purposes. In the event that there is a dispute on the <br /> amount of the job cost,the City may request the submission of a signed copy of the actual cont�act, <br /> • *'�The STATE SURCHARGE is.0005 of the contract price under 51,000,000 or$5.00—whichever is <br /> greater. For valuations ovar$1,000,000 call the Building Depariment at(95Z)249-4600 for the price. <br /> The undersignad hereby applies to the City for issuance of a Plumbing Permit, agrees to do a!1 <br /> work in strict accordanca with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> Applicant's Signature: D Date: �� - ay - �� <br /> i�r,r <br /> s � <br /> .,w i .�� . � <br /> 3 <br />