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04/18/2017 08:35 FAX 9529335049 CULLIGAN MNTKA �j003
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<br /> FIXTURE BSMT 1sT 2ND OTHER FiTMPEE BSMT ��oor Floor OTHER
<br /> NpE Floor Floor
<br /> Water Closet Floor Drains
<br /> Lavatory Sewer Ejector
<br /> Bathtub Laundry 7ray
<br /> Shower Washer
<br /> Kitchen Sinfc Water Heater
<br /> Disposal Water Softener
<br /> Dishwasher Wet Bar
<br /> Sillcocks Miscellaneous
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<br /> 1. CONTRACT PRICE ' is 1.25% of contract price with a (Minimum Fee of$50.00)
<br /> ��;��l , �� _x .0125 $ .�� 0�
<br /> (contract price) (minimum $50.00)
<br /> 2. STA7E SURCHARGE
<br /> x .0005 � ��
<br /> (contract price)
<br /> 3. POSTACE 8� HANDL[NG (Only on Mail-In AppEications) $ 2.00
<br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) � '�
<br /> * CONTRACT PRICE or JOS COST means the actual or estimated dollar amount charged for the
<br /> permitted work including materiaEs, labor, profit, and other fixed costs. It is the amount 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 contract.
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<br /> The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do a!I work in
<br /> st�ict accordance with the ordinances of the City and the regulations of the State of Minnesota, and
<br /> certifies that all statements made on this application are complete, true and co�rect.
<br /> Applicant's Signature: Date: 1�' ��+ r 7
<br /> Building Official/lnspector: Date:
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