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02/06/2017 10:36 FAX 9529335049 CULLIGAN hINTRA C�003 <br /> +.' _ , <br /> �. ,� .. ✓. .:rv.. .. . ��u- =' :!. ��.::.'W'jz.� ..�+.�: �� . ' _ '�J+. - ��,'i+�t�4�-'��'�,',��,-�'�' �;+¢!`;WtMYAx.'.d-p�k9:d�A. <br /> ..�::......�r � ,�t��� 7' .-._: �..1 - <br /> :,�. �,� _ _� �� _, w . �;.�.��.1111 ...�C;��:RE B:�I[:�k4�- - - - ��� -- <br /> �����,-���,��-�:��.�,.,�,"�.��.��� ��. ��l <br /> , <br /> : .. <br /> . __ <br /> '1'� <br /> � �` T� <br /> S.�';,;: .;:�1.�� <br /> , <br /> ..: '� :..���.� ..��.. <br /> ;.. - <br /> ...,... ... �. .. .......... <br /> �.m ... � -- <br /> � . <br /> �..lNaf.!s�:'n.�:... ri. ,L!1..._.._M ....,..�=--�..._. - <br /> FIXTURE BSMT 157 2"D OTHER FI�X�TPE E BSMT Floor Floor OTHER <br /> TypE Floor Floor <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> 8athtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Neater <br /> Disposal Water Softener � <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> �w,„ ,. . ,.. _ _ :l'�: ".e <br /> . �1 <br /> . �Fv . ' :�L.i�' <br /> . .i�. �<. <br /> . � <br /> .. .� . . .... .._ _....:._ . _. ... <br /> y. <br /> :� I <br /> ' <br /> � . ; <br /> `. <br /> ��' <br /> . . : - . .. :. __. . � . <br /> i � ..._. ... ... ,.�.....�e:_. ' <br /> 40Ei. - <br /> 1. CONTRACT PRICE 'is 1.25% of contract price with a(Minimum Fee of$50.00) <br /> a00 .b0 x.Q125 $ 5'0.0 l� <br /> {contract price) (minimum $50.00) <br /> 2. STATE SURCHARGE <br /> � x.0005 . $ ' � <br /> (contract price) <br /> 3. POSTAGE 8� HANDLfNG (Only on Mail-In Applications) $ 2.00 <br /> 4. TO7AL PERMIT FEE (Add Lines 'f-3 Above) $_„ s d . � <br /> * CONTRACT PRICE or J�B COST means the actual or estimated dolSa� amount charged for tha <br /> permitted work including materials, labor, profit, and ofher fixed costs. It is the amount ta 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 actual contract. <br /> �� • r•..: �_ . �"StR�t�lc��tr.T.l:!�G�7,.C,F�..'i'.'_,.k?L3`:8:: ^..8� a..l..:i'_ ___ '' <br /> ,_. <br /> . , <br /> _ <br /> .... <br /> -,. -�-„ � <br /> . <br /> ;, s . '' �.. � . � <br /> $",. �. o <br /> � . . . <br /> M � � ...��.:... . . <br /> �. ' ' <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 ancf the regulatians of the-State of Minnesota, and <br /> certifies that all statements made on this application are complete, true and correct. <br /> ApplicanYs Signature: Date: a J � � �� <br /> Buiiding Officiaf/lnspector: Date: <br /> Page z <br />