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04/19/2016 10:32 FAX 9529�35049 CULLIGAN MNTKA �013 <br /> y+;�!�a 1 � ' H �" �t'ir-�"i, r� n�.f,�'(' �Ch ��J h 4�•rdi�;j�y1��Llll"•1��� <br /> .'Cl�jl�?KN�1�If�r?���,��t�Fir'�` �;:� '�'��'�� "�''.� ���1�',�L7}�;,;J ,.D��Q�';�D.7�V;4�:�V',�rwrt�;'� <br /> If above does not apply;follow gvidelines below: <br /> 1. CONTRACT PRX� "is 1.25%of contract price with a�'Iinimnm Fec oi$50.00) • � <br /> 6V � . <br /> x.0125� <br /> (oonrract rice) (minimum sso.o0) <br /> 2. STATE Si1RC�ARGE **Add the 5tate Bldg Codc Div.Surchargc(Minimum Fee ofS5.00)> <br /> - �'� I <br /> X.000s s � <br /> (conuac�price) (mlaimum$ 5.00) � <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) 5 2.00 '" <br /> �� <br /> 4. TOTAX.PERMIT FEE(Add Lines 1-3 Above) S <br /> � * CONTRACT PRIC� o�10E COST means the aCtual or estimated dollar amount charged for the <br /> permitted work including matcrials, labor,profie,and other fixed costs. It is the amount to be eharged <br /> to the customer for the work done. If any material, equipment, labo�or installstions are fitmis6ed by <br /> the owner,tenant or any o�her party,thc re�sonable markez value of such items must bo added to the <br /> estimated cost or contract price for permit fee purposes. In the evcnt that there is a dispute on the <br /> amount of the job cost,the City may reyuest the submission of a signed copy of the ach�al contraet. <br /> + *'�The 57'A7'E SURCHARG�is.0005 of the contra�l;price under$1,000,400 or 55.00—whichever is <br /> greater. Far valuations over�1,000,000 cap the Buildin�Departrnent at(952)249-4600 for t�e price. <br /> ;�;r �f��a'� 3!��+�m;`�'T�}1'���.Y�����i�►, r ?� �••:;' t'l�!f'L�;` '� '0r�, �,��i"1�,71:'�;��`;'!i�1�±k'P•���i,w:�' <br /> +�d��.>;I�.,�i7•��IM1;'�,�IhM� ,Cu -P � <br /> 'The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do all <br /> work in strict aceordanee with the ordinances of the City and rhe regulations of the State of <br /> Minnesota, and certifies that all statements made on this applicarion are compiete, true and <br /> correc� <br /> Applicant's Signature: Date: ��f � ! � �.V <br /> ;���.�,��.�;W � ��e� <br /> 3;,;�,�t�,,. ;xi•:��„�.ym� <br /> 3 <br />