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il/14/2016 10:56 FA% 9529�35049 CULLIGAN MIVTKA 1�00a <br /> . • y� I� <br /> . <br /> :W�aiw�mqwwn�ni�4 ,�,�, �%+IunVHu�IV Mhly� ,-��y� �j, y�II � 11 � 1�I T i�b xM^�i���� �� i y�g�n�@� �� ��w�CN W� � <br /> �1iaN�i�i �,�,,+���. � li�' � G -0 ��[� 11 i lY 5 AM I �W�}�u <br /> �ll:,W.u.�'�`�` '��""� �����M �Sw�!a'�Can'i7:PL,�; �O i�47�1���,'U',l'f`'E "'�.' .'_� � ����°!���I�'f id ruaw <br /> �:�h.,`���n u� A�u' � w _ � �� �ii �ei �'.wi�i"��Imwy��Fn���wmn.�Yl'C..,�� <br /> FIXTURE �SMT 1sr 2ND QTHER FIXTURE BSMT �sT 2No qTHER <br /> TYPE Floor Floor TYPE Floor Floor <br /> Water Closet _ Fioor Drains . <br /> L.avatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> fGtchen Sink Water Heater <br /> Disposal Water Softener � <br /> pishwasher Wet Bar <br /> Silicocks Miscellaneous <br /> w W'�� �wjhuy'��e� ' 'I �•."" 4HL�N i �� A� ��'• � f "' y1,��� �y�ywy �y�y� ,� 4� <br /> N� M �e o�II^ . .� ��' � �/I�,VYti�,i ' � II '-,.`�' .W� �uAr � <br /> 1. CON7RACT PRICE "is 1.25°� of contract price with a (Minimum Pee of$50.00) <br /> x.0125 �$ <br /> (contract price) (minimum $50.0�) <br /> 2. STATE SURCHARGE <br /> x.0005 $ <br /> (contract pnce) <br /> 3. POSTAGE�HANDLING (On1y on Mail-In Applications) $ 2.00 <br /> 4. TOTAI.P�RMIT FEE (Add Lines 1-3 Above) $ <br /> * CONTRAC7 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 fumished by the <br /> owner, tenant or any other party, the reasanable 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 /> "7'�' me W'���„�„��� ��' �I�� ~.R�,l;a,"�1:••I.' I �� ��ir"�'":��',"::!imL;M�i�J�1�1i° ,�IM�1"6���Y hl� � I.� M„677.��h13?'�'"M <br /> � � �I�I� rn � 1. i Ma. me ..I <br /> The undersigned hereby applies ta the City for issuance of a Plumbing Permit, agrees to da all work in <br /> strict accordance with the ordinances of the City and the r'egulations of the State of Minnesot2�, �nd <br /> certifies that all statements mada on this application are complete, true and correc#. <br /> Applicant's Signature: Date: �I� � - � <br /> Building Official/Inspector: Date: <br /> Page 2 <br />