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09/07/2016 08:17 FA% 9529335049 CULLIGAN MNTKA C�OOa <br /> . <br /> iI��M"�J".��7nui"m nMa:in"m��n�n,a�w�,' ���'rhs"+'�I'.iGli?w�h i�"�l'J {��1 �±,�, �Q�-V,� " ,��.,�,'�7i��1���J+ ��'E1J,��"�n"._•.�""w�i" � i�e�'ww'�',��� ,wm w.�.�.��'"�.'°�'�� <br /> „�°:im�n�'��C".�7:.'���.�d��.k'yn�Po+im �n°o�' ��4�?�,����w_ !;i r i"J:1i w,ari�'iT�C::"J�'a"�".�'���^..aR;;SC^L"�.'�."�.�q7!r,'�.."�„W� <br /> FIXTUR� BSMT 1 2NO OTHER FiXTURE BSMT 1sT 2No OTHER <br /> TYpE Floor Floor NPE Floor Flaor <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Meater <br /> Disposal Water Softener � <br /> Dishwasher Wet Bar � <br /> Sillcocks Miscellaneous <br /> n16Y��w�� �x�i�4 �p;�' � M. M� IM n �^ �.���.�i'��IV I���.�I � i{ ��u•.�TY�n������ , N �� <br /> 9. CONTRAC'� PRIGE *is 9.25% of contract price�vrith a(Minimum Fee of$50.00) <br /> �O L� x.0125 $ , <br /> (contract price) (minimurn $5�.00) <br /> , , 2. STATE SURCHARGE . <br /> x.0005 $ <br /> (contract price) <br /> 3. POSTAGE S� HANDLING (Qnly on Mail-In Applications) $ 2.00 <br /> 4. TOTAL P�RM1T fiEE (Add Lines 1-3 Above) $ �a��� <br /> * CONTRACT PRICE or JOB COST me2�ns the actual or estimated dollar amount charged for the <br /> permitted work including materials, labor, profit, and other fixed casts. ]t is the amount to be charged to <br /> the customsr for the work done_ If any rnaterial, equipment, labor or installations are fumished by the <br /> owner, tenant or any other pariy, the reasonable market walue of such items must be added to the <br /> estimated cost or contract price far permit fee purposes. In,the everrt 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 actua( contracf. <br /> �,.�iUtlO a M�P � �I4r � M I w I �amn�QN y � <br /> s . .�.� ��!:�;�� ��P�� ',,, '��'T��"' ,� '' � ,C, � ,r � ��� � � <br /> 7he undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do al!work in <br /> strict accordance with the ordinances of the Ciiy and the regulations of the State of Minnesota, and <br /> certifies that a[I statement made an this application are complete, true and correct. <br /> Appficant's Signature: �� Date: � `7� �ib <br /> Building Official/Inspector: Date: <br /> Page 2 <br />