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04l07/2014 14:15 FAX 9529335049 CULLIGAN hINTRA �j004 <br /> � � . , <br /> �✓'r.':::..:y:;�t'y ;v:,:� : N <br /> "`.LY:+� �:L1',��.�J�� �.(r�. ��7�rtj' '� _y��T �.��?%� <br /> r.t1i.�`.I: <br /> .ii.; ..V.''7� �.AJi���Yl'?4, . .. F i�;,r:;4:':.'..� <br /> r........,...,......,... <br /> $; -�.�B:�,(�; :Q.�:�Q�:;:;;4�:;: .. <br /> . .. . . ... ,,; . <br /> ,:;.;>. <br /> If above does not apply;follow guidolines below: <br /> 1. CONTRAGT pRICE *is I.25%of contract price with a(Minimum Fee of$50.00) <br /> x.0125$ <br /> (contract price) (mimmum 550,00) <br /> 2. STATE SURCHARGE **Add the State B[dg Code Div.Surcharge(Mioimum Fee of 55.00) <br /> x.0005 $ <br /> (contract price) (minimum$ 5.00) <br /> 3. POSTAGE&HANDLING(Only on Mai1-In Applications} � 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) � ,oD <br /> • * CONTRACT PRICE or JOB COST means the actual or estimated do((ar amount charged for the <br /> permitted work including materials,labor,profit,and other fixed costs. It is the amount to be charged <br /> to the customer for the work done. If any material, equipment,labor or installations are ft►mished by <br /> the 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 contract. <br /> ■ **The STATE SURCHARGE is.0005 of the coniract prica under$1,000,000 or$5.00—whichever is <br /> greater. For valuations over$1,000,000 call the Building Departrnent at(952)249-4600 for the price. <br /> ,. <br /> �. �� ' � <br /> „�.,,,.. <br /> The undersigned hereby applics to the City for issuance of a Plumbing Aermit, agrees to do alt <br /> work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> Applicant's Signature: �G_ Date: y - 7 - )� <br /> ��:1�._ t�;�a'�o�. .� <br /> 3 <br />