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� ti <br /> ro ���� ���,����'���� �����.���'�1�����,.,.,. � ,.', �� h�..:.;;. <br /> FIXTURE BSMT 1sT 2ND OTHER FIXTURE BSMT 1sT 2ND OT ER <br /> TYPE Floor Floor TYPE Floor Floor <br /> Water Closet � �� � `�j Floor Drains � <br /> Lavatory � i � Sewer Ejector � <br /> Bathtub � Cj � 2, Laundry Tray ((� I <br /> Shower � I 2: Washer � � <br /> Kitchen Sink C� � Water Heater � <br /> Disposal � Water Softener � <br /> Dishwasher � � Wet Bar � <br /> Sillcocks Miscellaneous <br /> , °::'; �?"�t��IT:��� ' ��°1"�E�N ,� <br /> 1. CONTRACT F�RICE * is 1.25% of contract price with a (Minimum Fee of$50.00) <br /> �ar�°�' x .0125 $ <br /> (contract price) (minimum $50.00) <br /> 2. STATE SURC�HARGE <br /> x .0005 $ <br /> (contract price) <br /> 3. POSTAGE 8� ANDLING (Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PER IT FEE (Add Lines 1-3 Above) $ <br /> * CONTRACT PRICE r JOB COST means the actual or estimated dollar amount charged fo the <br /> permitted work including materials, labor, profit, and other fixed costs. It is the amount to be charg d to <br /> the customer for the wo k done. If any material, equipment, labor or installations are furnished b the <br /> owner, tenant or any o er party, the reasonable market value of such items must be added t the <br /> estimated cost or contr ct price for permit fee purposes. In the event that there is a dispute o the <br /> amount of the job cost, the City may request the submission of a signed copy of the actual co tract. <br /> x�.:.R . �f.�:. � l_�11�B��Gi PEF���'�"����° .. �° �.:'���:�T <br /> The undersigned hereb applies to the City for issuance of a Plumbing Permit, agrees to do all w rk in <br /> strict accordance with t e ordinances of the City and the regulations of the State of Minnesota, and <br /> certifies that all stateme ts made on this application are complete, true and correct. <br /> Applicant's Signature: �'(' � Date: <br /> Building Official/ Inspect r: Date: <br /> Page 2 <br />