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. , • <br /> PLUMBING FIXTURES BEING INSTALLED <br /> FIXTURE BSMT 1sr 2ND OTHER FIXTURE BSMT 1sT 2ND OTHER <br /> TYPE Floor Floor TYPE Floor Floor <br /> Water Closet R� � Floor Drains �, I <br /> Lavatory Jz„� � � Sewer Ejector <br /> Bathtub � Laundry Tray � � <br /> Shower �„J, � Washer R,1, ( <br /> Kitchen Sink 3 Water Heater � <br /> Disposal Z Water Softener <br /> Dishwasher I Wet Bar I <br /> Sillcocks � Miscellaneous <br /> PERMIT FEE CALCULATION <br /> 1. CONTRACT PRICE '` is 1.25% of contract price with a (Minimum Fee of$50.00) <br /> .� <br /> �S�30. � x .0125 � �9�• S� <br /> (contract price) (minimum $50.00) <br /> 2. STATE SURCHARGE <br /> .�S ���• � x .0005 $ Z �• �Z <br /> (contract price) <br /> 3. POSTAGE 8� HANDLING (Only on Mail-In Applications) $ � <br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ n��- �� <br /> * CONTRACT 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 furnished 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 Ciry may request the submission of a signed copy of the actual contract. <br /> PLUMBING PERMIT APPLiCATION AGREEMENT <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 and the regulations of the State of Minnesota, and <br /> certifies that all statements made this plic�tion are complete, true and correct. <br /> �° <br /> ApplicanYs Signature: Date: � Z�' `� <br /> Building Official/ Inspector: Date: <br /> Page 2 <br />