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':,.#�L������!)CC��� t������S'��.E� ' <br /> FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT 1sr 2ND OTHER <br /> TYPE Ffoor Ffoor TYPE Floor Ffoor <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 X <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> �ft�1ftT���CAG�l,��T�QN <br /> 1. CONTRACT PRICE *is 1.25% of contract price with a(Minimum Fee of 550.00) <br /> x .0125 $ <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE <br /> x.0005 $ <br /> (corrtract price) <br /> 3. POSTAGE 8� HANDLING (Only on Mail-In Applications) $ 2.00 <br /> � <br /> C�-' <br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ � � <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amourrt charged for the <br /> permitted work ir�c��ding r»ateriaJs, labor, profit, and other frxed costs. It �s the ama�nt to be charged to <br /> the customer for the work done. If any material, equipment, labor or installations are fumished 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 a�tual contract. <br /> �,:�B�ti����'�`��'L;�#����A����#� �, , ",` <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 application are complete, true and correct. <br /> � lApplicant's Signature: �' � _� Date: ) I �� �� <br /> � <br /> Building OfficiaU lnspedor: Date: <br /> Page 2 <br />