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,� 03/07/2012 13:48 FA% 9529335049 CULLIGAN �1VTKA f�004 <br /> I ^ ' . <br /> � - .. . _ . . <br /> " �i���'�.s; <br /> ,t. k. •j �.s t �s"�".. <br /> lf above does not apply;follow guidelines below: <br /> 1. �ONTRACT PRICE ;is 1.25%of contract price with a(Minimam Fce of SS0.00) <br /> - x.0125$ � <br /> (contract price) (minimum SS0.00) <br /> 2. E S C E **Add tfie State Bldg Code Div.Surcharge(Minimum Fee otS5.00) <br /> x.0005 $ ' <br /> (conaecc price) (minimum S 5.00) <br /> 3. POSTAGE&HANDLING(Only on Mail-in Applications) $ 2.00 <br /> I �,. . <br /> 4. TOTA.L PERMIT FEE(Add Lmes 1-3 Above) S�r� .O� _ <br /> n��'!"� " " ''. _",'. - _ _ _- , , �f�,�, <br /> 'i � • CON['EtACT PWCE or JOB COST mcans the actual ar estimated dollar amount charged for tha� <br /> ; permitted work including materials,labor,profit,and othee fixed costs. it is the amount to be charged <br /> ' . to the customer for the work done. If any matarial,equipment, Iabor or installstions are fumished by <br /> the owncr.tenant or any other party,the roasonable market value of such items must be added to the <br /> estimated cost or contract ptice for permit fee purposes. [n the event that there is a disput� on the <br /> ' amount of the job cost,the City may request the submission of'a sign� copy�of the actual contract. <br /> � � **Ttic STAT'E SURCHARC3E is.0005 of the contract price under$1,000,000 or SS.00—whichever is <br /> ! greater. For valuations over$1,000,000 call the Building Departrnent at(952)249-4600 for the price. <br /> ; The undersigned heceby applies to the City for issuence of a Plumbing Permit, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the State-of <br /> i Minnesota, and certifies that all statements made on this application are complete, true and � <br /> correct. <br /> Applicant's Signature: Date: 3- � � � ,� � <br /> ,I . <br /> II , • <br /> i � <br /> '' <br /> I <br /> �, 3 <br />