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.04/19/2016 10:a1 FA% 95293a5049 CULLIGAN MNTKA f�004 <br /> .:�a�n;r' ���f'r•;r y ,p �p y� a yyy�7��� r ��,'�•A, Q1n , ";; „ �r�;:•"'a c 9,�,,;t�,� <br /> ,'S�y ,GV, ��i;"y�r'�f" ,yl �� 'i�PE�=f.i �', ��,�V+�y: �'�1��� � y r'1�'„��y�����;', '��u,-I� �F�M <br /> `�� !. ��� o��•'r. ,�<<ti, 'S�!►��� '�����S�.�t�.� ���VJ,�' D�;y�,. <br /> Yf above does not apply;follow guidelines below: <br /> 1,. CONTRAGT PK)C� *is 1.25%of Contract price w�(Minimum Fee o�$50.00�� <br /> x.0125$ ✓O <br /> (contrac�pnce) (minimum 550.00) <br /> 2. S'I'A�'�SY1YtCHARGE **Add the Statc Bldg Code 174v.Surcherge{Minimum Fce of S5. ) <br /> x.000s $ ` 2 <br /> (ep�tfacz prix) (minimum S 5.00) � <br /> 3. POSTAGE&HANDLrNG(Only on Mail-In Applications) $ 2.00 ,� <br /> y-� �� <br /> 4� TO'I'AL PERMIT FEE(Add Lines 1-3 Above) S V <br /> ■ "` CONTR.ACT PRICB or ]OB COST mesns the actual or estimated dollar amount charged for the <br /> permitted work including matcrials, Isbor,ptofit,and other fixed costs. It is the amount tp be chargcd <br /> to the customer for the work done. If any mattrisl, equipmen� Iabor or installations are fumished by <br /> the owner,tenant or any other party,the raasonable market value af such items must be added to the <br /> estimated eost or contract price for permit fee ptuposes. In the event that there is a dispute on the <br /> amount of the job cost,Lhe City may request thc submission of a signcd eopy of the actual contract. <br /> ■ *'�Thc STATE SURCF3ARGE is_0005 of the contract pricc under$1,000,000 or 55.00—r�vhiehever is <br /> greater. For veluations over$1,004,U00 call the Building Department at(952)?49-4600 for the price. . <br /> ������,'�.+����lrf+r'�"�O�I:ti7'bi1�, .�1!� ''�#r�1��C'� ����'R�'�� 'Y��.��di"i��1i1 �.+'���.al w�7�li'�l��h <br /> �'`L•Yi <br /> The undersigned liereby applies to the City for issuance of a Plumbin� Permit, agrees to do all <br /> work in sirict accordance with th� ordinances of the City and the regulations of rhe State af <br /> Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> Applicant's Signature: Date: � <br /> �`�n�:�y�;�,,�F�f�� <br /> ";;+rJ;�� r�n;'�}�.���^:!,c f. <br /> 3 <br />