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02/28/2012 19:48 FAx 763�773629 . 009f009 <br /> _ . . ��a ����/�� �k"'� �la� . <br /> . <br /> ,. <br /> !f above does nqt apply;Eollow guidolines below: <br /> 1. CbNTRACT PRiCF. +'is 1.2S%of contract price with a(Minimum Fee oi$50.00 <br /> � �� <br /> x.0125 S <br /> (con![acl priCe) (mlaim�m <br /> 2. STATE SURCHARGE � � � <br /> ���� x.0005 S <br /> (�+�P�) <br /> 3. PQSTAGE&Fi�iI�IDLING(Only on Mail-Tn Applications) S <br /> 4. I TAL PERMIT-FEE Add Lines 1-3 Above - S <br /> T� ( ) <br /> , r. ,::�. ,., ,, �;�+-GONT CF�R-lEE or JOB COST moens thc actual or estimatcd dollar amount charg for th - r r� :^�a <br /> permitte�v�rork including materials.labor,-profit,and ot6er IIxod costs. it is che amount to b char <br /> ` t�the cu Wtner�for the work done. If any matc�'ial,cquipment, labor or installations ar� ishcd <br /> the own ;"tenant or any other parry,tbe reesonsble market value of such icems must be to th <br /> estima cost or cont�act price Eor pertnit fee purposes. In the event that there is a dis on th <br /> amount�f the job cast,the City may request the submission pf a signed copy of the a�tual n <br /> :_ _ _ <br /> , <br /> ��!!�il '� ,•'�,n,.�•,?� '` �:� { <br /> The under�igned hereby applies to the City for issuance of a Plumbing Permit, agrees do Il <br /> work in s�rict accordance with the urdinances of the City and the rebulalions of the tate f <br /> Minnesotaj, and certifies that all statemems made on this application are complete, e d <br /> correct. <br /> �� <br /> Applicanti�'s Signature: ��:� <br /> � ( <br /> I <br /> ' 7 <br /> 3 <br />