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• 08,/22/2016 10:28 FAX 95293a5049 CULLIGAN DINTKA �OOa <br /> I�� �y�I� �itlfy :��sW. flr•���YF�+i7�� ���C L� �j'�C��rI�n�1 �Yf�7 i�����A�"�.��MwJ ���s�'0 �iu ��'n."°� �rM <br /> MiJ�I�r"�°�"���,r�",�Y"ri ��C'RWI.iP wn�"�Ir nw p i�ei�!��7:.i:i�;A+��� 4Mu.`:GQ�D�I�U.`:�L1'�4?1��1 ��"V;L'tl"��Iw��:M� ���� �� �n�'�,'�x"�"��� <br /> I�'�' , �N'M' i�ii�2M�� ;, . 1� .. ._7R5'� w"�$�wG1�.!7W191.,.M1� "'is <br /> FIXTURE BSMT 9'ST 2ND UTMER FIXTURE BSMT �sr 2N0 OTNER <br /> 7YPE Floor F1oor NPE Floor Floor <br /> Water Closet Floor Drains <br /> ��tQry Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower . Washer <br /> Krtchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> " I� �PdSl7 ��. ,p��e,,,, m 4?,7.+P.�!I!RC.eii Y�`�3'��,w li!i'+'�" � '� �� r'6' m +WN �"�� <br /> 1. GONTRACT PR10E "is 1.25% of contract price with a(Minimum �ee of$50.00) <br /> x .0125 $ <br /> (contract price) (minimum $50.00) <br /> 2. STATE SURCMARGE <br /> x _0005 $ <br /> (contract price) <br /> 3. POSTAGE 8� HANDLING (Only on Mail-tn Applications) $ 2.00 <br /> 4. TOTAL PERMIT F�E (Add Lines 1-3 Above) � •�5 <br /> * CONTFZAGT PR10E or JOB COST means the actuaf 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, fabor or installations are furnished by the <br /> owner, tenant ar 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 t(�at 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 /> �ni�r �w �~ an"��.u ry ,��6C�'4e?� ��4'�II�!�!l����� rh���t��{Ic�'."�'' '�� ,9.d .n"G�i �6�9 "" Wwul�'�:II <br /> The undersigned hereby applies to thE City for issuance of a Plumbing Permit, agrees to do al{ 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 on this apptication are complete, true and correct. <br /> ApplicanYs Signature: Date: � " ��.� �b <br /> Building Official/Inspector. Date: <br /> Page 2 <br />