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PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1ST 2ND OTHER FI�PEE BSMT 1sT 2ND OTHER <br /> �rpE Floor Fioor 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 �ar��C�. <br /> Sillcocks lti�s�cellan ous � <br /> PERMIT FEE' CALCULATION <br /> �r <br /> 1. CONTRACT PRICE "` is 1.2-5% of contract price with a (Minimum Fee of$50.00) ✓�t(I . <br /> /� c`X% <br /> .-„-._., .,_.:�.r_..�'_�.� ��C_... � L r,/ <br /> r`��r ��� ` x .0125 $�.....:�i�`� —_ <br /> (contract price) (minimum $50.00) <br /> 2. STATE SURCHARGE r� l��,3 <br /> x .0005 $ <br /> (contract price) <br /> 3. POSTAGE & HANDLING (Only on Mail-In Applications) $ _ <br /> �v <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. <br /> PLUMBING PERMIT APPLICATION AGREEMENT <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 statemen� made on this,ap�ation are complete, true and correct. <br /> , ;� f - - . :�-�_ . s y -Z ��". <br /> l ���., <br /> Applicant's Signatur�: , �� ""---�� _ Date. <br /> /' <br /> ,: <br /> Building Official/ Inspector: Date: <br /> Page 2 <br />