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i0/la/2416 FRI 8: 39 FAx 651 730 9a00 xNw GROVP I�OOz/00z <br /> , , <br /> FIXTURE BSMT �sr 2ND OTHER FIXTURE BSMT 1aT 2ND OTHER <br /> TYPE Floor Floor TYPE Floor Floar <br /> Water Closet � � Floor Drains <br /> Lavatory � ,� Sewer EJector <br /> Bathtub . � � L�undry Tray ' <br /> Shower a Washer � <br /> Kitchen Sink � Water Heater <br /> Dlsposal , Water Soft�ner <br /> C7ishwasher , Wet Bar + <br /> Sillcocks a Miscelleneous � <br /> 1. CONTRACT PRICE }Is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> �/ �" `" x.0125 $ <br /> �ontract price) (minimum$50.00} <br /> 2. STATE SURCHARQE <br /> _ __x .0005 $ <br /> (contract price) <br /> 3, PQSTAG� 8� HANDLING (Only on Meil-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE (Add Lines 1�3 Above) a <br /> * CONTRACT PRICE or JQB CQST means the ackual or estlmated dollar amount charged for the <br /> permitted work including materials, labor, prafit, and other fixed costs. It is the amount to be charged to <br /> the customer for the work done. If eny materi�l, equipment, labor or installations are fumished by the <br /> owner, tenant or any �ther party, the reasonable market value of such items must ba added to the <br /> estimated cost or contract price fcr permit fee purposes. In the event that there Is a dispute on the <br /> amount of the job cost, the Clty may request the submission of a signed copy of the actual contrect. <br /> The undersigned hereby applies to th� City for issuance of a Plumbing Permit, agrees to do all wark 1n <br /> str(ct accordance with ihe ordinances of the City and the regulations of the State of Minnesota, and <br /> ce�ifies that all statements made on this application are complete, true and correct. <br /> Applicant's Signature: �r�� �~ Date: �a '�� /w <br /> Building OfficiaV(nspector; Date: <br /> Page 2 <br />