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12/26/2017 11:14 FAX 9529335049 CULLIGAN MNTKA Lj 003 <br /> „ , , PLUMBIIN.GFIXTURES BE(NG INSTALLED <br /> FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT 1sT 2ND OTHER <br /> TYPE Floor Floor TYPE 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 /> st "*�.'� '{'dl.t i# �x r� "� 8`.af71�.�.,� s �./'.'� 4 .<r p R-� +E i" „y'Yt�.ga j*"s��a.. � Sri 7. ,�,, k <br /> a �#�:�#?,i4 W'.+.�, M c ,}ids,.< fi� �.. PI .`ERMIt FE•eil'aSta ltk'W.,�"re_vr t •7,''�'at'��T,•"':'�.,•T A„N:•'�.Ii t,i {w <br /> • -- 1. CONTRACT PRICE *•is 1:25% of contract price with a (Minimum Fee of$50.00) ... - - - ' <br /> cD199, 00 x .0125 $ 5o. ab <br /> (contract price) (minimum $50.00) <br /> 2. STATE SURCHARGE <br /> x .0005 $ 1. 1 0 <br /> (contract price) <br /> 3. POSTAGE & HANDLING (Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ S3 , 10 <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 City may request the submission of a.signed copy of the actual contract. <br /> r `` FI IVI61kG,.PEEZM T AR!?LEM1ON�`A'_ORE IIENMEgi`i f ,c, fi..... <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 /> L;' ii) c.--.*,0- <br /> Applicant's Signature: Date: ID--ab - 17 <br /> V <br /> Building Official/ Inspector: Date: <br /> Page 2 <br />