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05/02/2017 08:32 FAX 9529335049 CULLIGAN MNTKA [�003 <br /> ;- a ...;:: f , �. ; Pl.U:MB.(NG FIXTURES_BEING:.I�ISTAL�'ED ' ` `'' <br /> � <br /> � FIXTURE BSMT '{ST 2ND OTHER FIXTURE BSMT 1sT 2"D OTHER <br /> TYPE Floor Floor TYPE Floor Floor <br /> Water C(oset Floor Drains <br /> Lavatory ( Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Neater <br /> Disposaf Water Soffener ' <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> 'k'�� ..�_g .. '.. .� �' ���."r�.. . ,_:,r; . � '',.;'�.PEF�MfT:FEE CAL.GU';LP+,TEON : z �` , . � <br /> a .�,. � _ <br /> 1. COM1iTRACT PRiCE * is 125% of contract price with a (Minimum Fee of$50.00) ; <br /> , � �'' <br /> 1yqQ . �� X .o�2s � '�.�- <br /> (contract price) (minimum $50.00) <br /> 2. STATE SURCHARGE <br /> f ,. <br /> � x .0005 $ � l �'1 <br /> (contract price) <br /> 3. POSTAGE � HANDLiNG (Only on Mail-!n Appiications) $ 2.00 <br /> 4. TO7AL PERMIT FEE (Add Lines 1-3 Above) $ Sa,�-5 <br /> "' CONTRP,C7 PRICE or JOB COST means the actua! or estimated dolfar amount charged for the <br /> permitted work including materials, labvr, 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 capy of the actual contract. <br /> ; ��� " ,,� � h�` � P,,L.UM�I:NG :P�R11Af:T,AP..PLICAT�ONHAGI�EEI�IIENT'�; �... �; "�...�; y �, �d�.�, �...; <br /> �� .,... � <br /> The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do afl work in <br /> strict 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 correct. <br /> Applicant's Signature: Date: -5- a ` ,� <br /> Building Official/ Inspector: Date: <br /> Page 2 <br />