|
05/16/2017 07:54 FAX 9529335049 CULLIGAN MNTRA f�003
<br /> �
<br /> .
<br /> , _ ;.. ,:�,;�
<br /> �.... ..w_.. . __ ...,,. ���•' - - - - -
<br /> < ,. ��,,�. z:,t:a
<br /> , . . . . �,i;:,.: cr+;�
<br /> .� ,... .�:,•._... , . r �A,�, . -
<br /> �-. . �.. , .-... � -. :� <+ :�*%"� r:�..
<br /> =`
<br /> :.
<br /> ......,...;.,.;;......,c:�.:�!.F.�.o:i• �F�:.:. �..9.A�.::F.-..A:.� . ...a� . . . [ � _ -
<br /> :i;�: g- . .� �,":•..,5:t,"'*�.�"�n.
<br /> �:�.:�,.. :...._��..�;,._:��.....:_ ��,.:.:�.:. _ :.�...::�-..�: :: .. � . .: �., ; .. . .. =a`�T.^.-�:�lr_.�',�'-_�� -
<br /> .{�,: +�.�:,:.�._+,.�. cy..,...-_.�t ,z. ....-a. :.a.. 17:t:.y -
<br /> �:. _.:,.::�y. � �x,_.._r._ �. .,:�Uf1�Bl[�:�:��I�T�.:a -
<br /> �r....:t�=.. ,, �. ,,..��� ��.;;..�-.P. -
<br /> 'v#.,,:_ w.-:.YSw��..:.a�.::.tt� �.:.n�r..nM,. ..Y.
<br /> ._...,_... ,,. E.:.. ��''�t,�T�
<br /> .Ed , ;,;S�A4':�E �:�:z
<br /> _:.`
<br /> .
<br /> �. --
<br /> a
<br /> ..............
<br /> ,:. �. ��;a�:�
<br /> ,9--. 5�.ni�.na:a�-�:.:. .:....a.._.i_..::.. ...,..,. ...
<br /> FIXTURE BSMT 1sT 2"o OTHER F{�XYTPEE gSMT �sr 2ND 07HER
<br /> Typ� Floor F{oor Floor Floor
<br /> Water Closet Floor Drains
<br /> Lavatory Sewer Ejector
<br /> Bathtub Laundry Tray
<br /> Shower Washer
<br /> Kitchen Sink Water Heater
<br /> Disposal Water Softener
<br /> Dishwasher Wet Bar
<br /> Sillcocks Miscelfaneous
<br /> ,:: �`
<br /> . _ ...�.�. �a=.1c+.:;": :ar�w _ i.. .Ka" - �:.�n,T,-" !I�r�.� rk�*'?N�,�;_;�F'
<br /> ".' " '
<br /> � � +�'- �`''M'a �rr .. ...''�7��'s` ,� ?a .'_„ '•�, �� ..i1� _ �av:: <iif.�'.�an..R'�ri.sa.4::�'A..�.'�;sR.
<br /> ,y,.: �.��. 4 :..� N�,Zv��+. _'_..�a�e:��..��:;n::-:�F.°',H'� - -
<br /> :,
<br /> ...;
<br /> i:..
<br /> ����
<br /> •
<br /> ..
<br /> _..�a ,�"G�.��: . ,.:..:�:,.
<br /> �...,
<br /> ,:..... �..::;: .�
<br /> ,.
<br /> �_:...
<br /> �
<br /> .m.
<br /> ,;
<br /> z. r�
<br /> a..:....,. _,,...;.....:::
<br /> ^ .. �:�..
<br /> .,,. .
<br /> •,
<br /> ,� . �� ,......... ..�.,.
<br /> _ .._. ..... .
<br /> 1. CONTRACT PRICE *is 1.25% of contract price with a(Minimum Fee of$50.00)
<br /> �y9 . oD X.a��S � 50,0�
<br /> � (contract price) (minimum $50.00)
<br /> 2. STA7E SURCHARGE
<br /> x .0005 $ I . 3�
<br /> (contract price)
<br /> 3. POSTAGE� HANDLfNG (Only on Mail-In Applications) $ 2.Ob
<br /> 4. 7�TAL PERMIT FEE (Add Lines 1-3 Above) $ �3' 3�
<br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the
<br /> permitted work including materials, 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 instaltations are furnished by the
<br /> owner, tenant or any other party, the reasonable marke# vafue of such items must be added to the
<br /> estimated cost or contract price for peRnit fee purposes. In.the event that there is a dispute on the
<br /> amount of the job cost, fihe City may request the submission of a signed copy of the actual contract.
<br /> x , . - -- �'�°" � ����
<br /> � . � t. . ,. ; + �,y p� '{'
<br /> =
<br /> . — _ _�..;�.. ��i� ;� -
<br /> ;a ...
<br /> �. , , �., ,:. -
<br /> .. , :.... ,., .�:.:.. _ _. ;s ." - #J'-_
<br /> �. _ . .�.. ...... „ �� , ���: ��.�'C+Yti7m�u.._. ���.��.
<br /> � y.�� �i ..�..,�;;tfi.. ... ..,. .�.�5't .r. ..................�tx4... �.,._.. . - -
<br /> -, .
<br /> ,
<br /> .� �. ;� !'a�t,:�.:�r...
<br /> ..
<br /> '
<br /> w.
<br /> r
<br /> � �:::. �... ,�:��K.�� :!„�:�i r�iu
<br /> :��..... �,.:�:..:..'
<br /> .. � .,
<br /> _ . . .: '
<br /> _.
<br /> � : . .,..::.�,: .......���.,,�..:��,.......
<br /> � ...,,��:�.a...,..�_ . ,�... .. . :....._�.
<br /> �.......__ . . .
<br /> The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all work in
<br /> strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and
<br /> certifies that alf statements made on this applicatio� are complete, true and correct.
<br /> Applicant's Signature: � Date: -5 � ( ' 1
<br /> Building Official/[nspector: Date:
<br /> Page 2 •
<br />
|