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05/11/2017 09:10 FAX 9529335049 CULLIGAN MNTRA C�003
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<br /> FIXTURE BSMT isr 2ND OTHER FIXTT�pEE BSMT Floor Floor OTHER
<br /> '�YPE �loor F1oor
<br /> Water Closet Floor Drains
<br /> Lavatory Sewer Ejector
<br /> Bathtub Laundry Tray
<br /> Shower Washer _
<br /> Kitchen Sinlc . Water Heater
<br /> pisposal Water Softener
<br /> Dishwasher Wet Bar
<br /> Sillcocks Miscellaneous
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<br /> 1. C�NTRAC7 PRICE * is 1.25% of contract price with a (Minimurn Fee of$50.00)
<br /> ayq�. o� X .o,�� � 50.0�
<br /> (contract price) (minimum $50.00)
<br /> 2. STATE SURCHARGE
<br /> x .0005 $ j . a 5
<br /> � (contract price)
<br /> 3. POSTAGE &HANDLING (Only on Mail-In Applications) $ 2.00
<br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ ''S'3' a'`�
<br /> " CONTRACT PRiCE or JOB COST means the actual or estimated dollar amount charged for the
<br /> permitted work including materiais, 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 ta 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 ali 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 comp{ete, true and correct.
<br /> � Date: �-.� s- I f = l 7
<br /> Applicant's Signature: - —
<br /> Suifding Officiall Inspector: Date:
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