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<br /> If above does not appty;follow guidelines below:
<br /> 1. CONfRAC'T PRICE *is 1.25%of tract price with a(Minimam Fee of$30.00)
<br /> D� X.atzs s -rb , �
<br /> ( � ��) c�a��sso.o4,
<br /> 2. STATE SURCHARGE �t�.�
<br /> x.0005 $
<br /> (co�ct Price)
<br /> 3. POSTAGfi 8t HANDL]NG(Only on Mail-In Applications) $ 2.00
<br /> �p3� p�S
<br /> 4. TOTAL P�RMIT FE�(Acid Lines 1-3 Above) S
<br /> ■ * CONTRACT PRICE or JOB COST means the �ctual or estimated dollar amount charged for the
<br /> per�nitted work including materials,labor,profit,and other fixod costs. It is the amount to be charged
<br /> to the customer for the work dona. If any maurial,a�uipment,labor or insialladons are furnished by
<br /> the owner,tenant or any other party,the reasonable market value of such items must bc added to the
<br /> estimataf oost or cflntract price for permit fee purpos$s. In the event that ti�ere 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. �
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<br /> The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all
<br /> work in strict accozdance with the ordinan.ces of the City and the regulations of thc State of ,
<br /> Minnesota, and certiSes that all statements made on this application are complete, true and
<br /> correct.
<br /> A licant's Si �ll"� D�; 11/21/11
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