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� <br /> �`` Pd.:1JM$�'�F���1f���"i;`�����`1N�''��;,� � ��r� <br /> FIXTURE BSMT 1sr 2Na OTHER FIXTURE BSMI' 1sr 2ND OTHER <br /> TYPE Floor Floor TYPE Floor Floor <br /> Water Gloset � ��-- � Fiaor Drains �� <br /> Lavatory a Sewer Ejector <br /> Bathtub � � � L.aundry Tray p� <br /> Shower � , Washer � � <br /> Kitchen Sink � Water Heater ' <br /> Disposal Water Softener <br /> Dishwasher � Wet Bar � <br /> Silicocks `7 Miscellaneous � <br /> PER�UII?`.FE� C��t�l�'CI�� � �. . <br /> 1. CONTRACT PRICE *is 1.25%o#contract price with a{Minimum Fee of$50.00) <br /> �`� ��5� � o X .0,�5 � (��C�� 31 <br /> (contract price} (minimum$50.00) <br /> 2. STATE SURCHARGE <br /> _ 4:...J�� �Q��C?C� x .0005 $ ��• � � <br /> (contract price) <br /> 3. POSTAGE 8 HANDLING (Only on Mail-In Applications) $ 2.00 <br /> � � � <br /> 4. TOTAL PERMfT 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. tf any material, equipment, labor or instaliations 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 /> amvunt of the job cost, the City may request the submission of a signed copy of the actual contract. <br /> PLUI�tBfN�F�Rlt�t���,����I�f��'�CJf'�J���t�11A�NT, : . ,° � <br /> The undersigned hereby applies to the Ciry for issuance of a Plumbing Permit, agrees to do all work in <br /> strict accordance with the ordinances of the City and the regula#ions of the State of Minnesota, and <br /> certifies that all stateme�ts made on this application are comple#e,true and correct. <br /> Applicant's Signatur � Date:�J��� <br /> Building Official/ Inspector: Date: <br /> Page 2 <br />