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O1/12/2010 09:50 FA% 9529335049 CULLIGAN MNTRA f�004 <br /> 4 <br /> m - � • <br /> I � <br /> . y;:i�r�.�.�,..f,m��t;°.�;�.,jp�yj�i�"��(� �, /� �.�•re::r,. .'r,"'" • '' '° '" � ��. ��e�.-•, <br /> �f.� :t1C'".'r..?:ri.� %i� ;��tlC71'i�5ai'�+4x���. ���+• i..., �.,' ^}^ 6u:9,+�`.�'. a:?Y.�!;•.� � <br /> Tf above does not apply;follow guidelines below: <br /> 1: CONTRACT PRICE * is 1.25%of contract price with a(Minimum Fee of 535.04) <br /> x.0125$ <br /> (contrect price) (minimum$35.00) <br /> 2. STATE SURCHA�RGE '*Add the State Bldg Code Div.Surcharge(Minimum Fee ofS.50) <br /> x.0005 $ <br /> (contract price) (minimum$ .50) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) S --i� �. 0 O <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �1 • 5� <br /> � ■ * CONTRACT'PRICB or JOB COST means the actual or estimated dollar amount ct�arged for the <br /> permitted work including materials,labor,profit;and other fixed costs. It is the amount to be charged <br /> to the customer for the work done. If any material,equipment, labor or installations are fumished by <br /> tha owner,tenant or any other party,ti�e reasonable market value of such items must be added to the <br /> estimated cost or conhact price for pemut fee purposes. �n 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 /> � *''The STATE SURCHARGE is .0005 of the contract price under$1,000,000 or$.50—whiehever is <br /> greater. For valuations over$1,000,000 call the�uilding Department at(952)249-4600 for the price. <br /> , + <br /> The undersigned hereby applies to the City for issuance of a Plumbing Permit, agraes to do all <br /> work in strict accordanee with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that all statements made on this application aze complete, true �and <br /> correct. <br /> Applicant's Signature: Date: �' �a - � <br /> , I' . <br /> 3 <br />