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c,) <br /> 0 = .. <br /> o PMati x X7Fi 1. ? tni v ~'j • <br /> O <br /> O <br /> d FIXTURE BSMT 1sr 2"o OTHER FIXTURE BSMT 1ST 2N° OTHER <br /> TYPE l Floor Floor TYPE Floor Floor <br /> co i <br /> Water Closet ti Floor Drains ( I <br /> Lavatory y I Sewer Ejector <br /> Bathtub Laundry Tray I • <br /> O Shower )-- Washer 1 <br /> Kitchen Sink I I Water Heater <br /> r Disposal ( Water Softener <br /> O <br /> N I Dishwasher ( Wet Bar <br /> � ' S: <br /> N Miscellaneous I <br /> N Silicocks l___ <br /> 1- R5iggniWr=f x ,O tfi : ., 1' x,' aigigi Upro. : <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> ✓* 0--Ot x.0125 $ <br /> ?contract price) (minimum$50.00) i' <br /> 2. STATE SURCHARGE <br /> x.0005 $ <br /> (contract price) <br /> 3. POSTAGE&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 estimated dollar amount charged for the N <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 /> Mafir s, ,, .4 <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 on this application are complete,true and correct. • <br /> N Applicant's Signature: "'P1'"1- k_'t Date: ick,e 1`1 <br /> v <br /> rr, <br /> m <br /> d• Building Official/Inspector: Date: <br /> 0 <br /> co <br /> N <br /> E Page 2 ;* <br /> 0 <br /> L <br />