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i � � <br /> JXTIJRES:� 1�ICtiA 11�5T,AL�.f D e 'u =,Y `T ` `� r k r <br /> ..... , �LL1�i8i�vC � <br /> FIXTURE BSMT 1sT 2ND OTHER FITMPE E BSMT Floor Fioor OTHER <br /> -rypE Floor Floor <br /> Water Closet Floor Drains <br /> Lavatory Sewer Ejector <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> x� 'r K. � ,� � i� ]Y►��� ��3+. � -�L� i '`� �,r;.�, t s� :�;� a.� <br /> ...�. .�r � - <br /> 1. CONTRACT PRICE * is 1.25% of contract price with a (Minimum Fee of$50.00) <br /> �� �� x .0125 $ <br /> (contract price) (minimum $50.00) <br /> 2. STATE SURCHARGE <br /> x .0005 $ <br /> (contract price) <br /> 3. POSTAGE 8� HANDLING (Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ <br /> * CONTRACT PRICE or JOB COST means the actual or estirraated 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 City may request the submission of a signed copy of the actual contract. <br /> � ,�'Li�:��31�1C� P�RM1'���P�����;�1�31��;���lll�fi ^� _ .�,:� <br /> � t: _ - <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 /> cert�es that all statements made on t ' ap ' tion are complete, true and correct. <br /> Applicant's Signature�! <br /> Date: �� � � � � 7 <br /> Building OfficiaU Inspector: Date: <br /> Page 2 <br />