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<br /> FIXTURE BSMT 1sT 2ND OTHER FIXTURE BSMT 1sr 2ND OTHER
<br /> TYPE Floor Floor TYPE Floor Floor
<br /> Water Closet � Floor Drains
<br /> Lavatory ! 3 Sewer Ejector
<br /> Bathtub j Laundry Tray
<br /> Shower I Washer j
<br /> Kitchen Sink Water Heater
<br /> Disposal I 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 /> ��7. ��� x .0125 $ �tg�;o?S•-
<br /> (contract price) (minimum $50.00)
<br /> 2. STATE SURCHARGE
<br /> d � �
<br /> � x .0005 $ � �`S
<br /> contract price)
<br /> 3. POSTAGE 8� HANDLING (Only on Mail-In Applications) $ 2.00
<br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ � �� � ��
<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 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 all 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 lication are complete, true and correct.
<br /> Applicant's Signature: Date: �
<br /> Building Official/ Inspector: Date:
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