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FIXTURE BSMT 1ST 2ND OTHER FIXTURE BSMT 1sT 2N0 OTHER <br /> TYPE Floor Floor TYPE Floor Floor <br /> Water Closet f 1 I Floor Drains <br /> Lavatory // / / Sewer Ejector <br /> Bathtub • r! // / Laundry Tray <br /> Shower ( i. Washer <br /> / <br /> Kitchen Sink / Water Heater <br /> Disposal Water Softener <br /> Dishwasher Wet Bar <br /> Sillcocks Miscellaneous <br /> r" i , .. <br /> z..0 .,,.s.i:......,. ,. ...> d;a ,dr,....t{rtPn,� <br /> 1. CONTRACT PRICE * Is 1,25%of contract price with a (Minimum Fee of$50.00) <br /> aCioC s x .0125 $ /CI—wiz– <br /> (contract <br /> CI' wiz–(contract price) (minimum $50.00) <br /> 2. STATE SURCHARGE �{ <br /> x .0005 $ /. ice,,, <br /> (contract price) <br /> 3. POSTAGE & HANDLING (Only on Mail-In Applications) $_ 2.00 <br /> cP6 <br /> 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ / O 771:3– <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 /> 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 m on this a. . ation are complete, true and correct. <br /> Applicant's Signature: Date;44-7/Z2_ <br /> Building Official/Inspector: Date: <br /> Page 2 <br /> Z abed 17ZZ 21.LE9L 6Wgwnld /caglil Wdgg'Z 6 81.0Z EZ Uef <br />