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R •• <br /> FIXTURE BSMT 1sr ZND OTHER FIXTURE BSMT �sT 2ND OTHER <br /> TYPE Floor Floor TYPE Floor Floor <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher I Wet Bar <br /> Silicocks Miscellaneous <br /> 1. CONTRACT PRICE " is 1.25% of contract price with a (Minimum Fee of$50.00) <br /> �� . ���j x .0125 $ �� n�, <br /> (contract price) (minimum $50.00) <br /> 2. STATE SURCHARGE <br /> X .000s $ <br /> �- a,S <br /> (contract price) <br /> 3. POSTAGE � HANDLING (Only on Mail-In Applications) $ 2.00 <br /> i <br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) a �o� � v2� <br /> " CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work including materialsf !abor, prof#, a!�d oths�fixed costs. !t is the anount to be charged to <br /> the customer for the work done. If any material, equipment, labor or installations are furnished by the <br /> owner, tenant or any other party, the reasonable market value of such items must be added to the <br /> estimated cost or contract 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 contraet. <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 regulations of the State of Minnesota, and <br /> certifies that all statements on this app'cation are complete, true and correct. <br /> Applicant's Signature: � Date: � '� I`l � � � <br /> Building Official/ Inspector: Date: <br /> Page 2 <br />