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02/28/2012 19:47 FAX 7634775629 �006/009
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<br /> If above dbes not apply;follow�idelines below:
<br /> 1� CONTRA(T PRICR *is 1.259�6 of conlract pcice with a(Minimum F'cc of 5511.00
<br /> � � x.01255 O'
<br /> , contract price) m nimom SSO �
<br /> 2a� STATE 3URCI�ARGE � �
<br /> x.0005 $�.,,_
<br /> (contract prix)
<br /> 3, POSTAGE 8c HANDLIIVG(Only on Mail-In AppIications) S
<br /> 4. TOTAL PERMIT.FEE(Add Lines 1-3 Above) S
<br /> � - ��• �--"�CpiJTRA�T�'R�EE or JOB COST means the ectual or estimated dollar amount chsrg fur tNe �� ,. ,�,�,
<br />� . permittvd w�ork including materiaJs�labor,profit,and other fixed wsts. It is t�e amount to b ch
<br /> to the j cuswmer for the work done. If arry material,equipment, labor oc insrsll�tioqs are fu sh by
<br /> the owner,teaant or any other peKy,the reasonable m�ket value of such ltems must be d to thc
<br /> estim�ced eost or contract price fvr permit fee purposes. In the event that there is a disp oa the
<br /> amou�t of the jab cost,the City may rcquest the submission of a si�ned copy of thc aetual n �
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<br /> The nndersigned hereby applies to the City fpr issuance of a Plumbing�Permit,agrees do all
<br /> work in Strict accordance with the ordinances af the City and the rebulations of the ta of
<br /> Minnesot�, and cert'tftes that all statements made on this application are wmpletc, e d
<br /> correct.
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<br /> ApplicanCs Signature: • , Date•
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