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N 'i ' <br /> � � �-_a :P�:LJ,#�B��C-�,ffX'3'UR�$ 8�1 � Cr��fST�+►1����r Y _ .v w :,,: � . <br /> �4fi'<.�. 'a - . <br /> I <br /> FIXTURE BSMT 1sT 2ND OTHER FIXTURE BSMT �sr 2ND OTHER " <br /> NpE 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 /> 3 :,k y IT� I . ,�.-.���, ���,f +��-'T';:,���� - ��� � � _ L "i E �f. <br /> �d r_ <br /> 1. CONTRACT PRICE * is 1.25% o�lf contract price with a(Minimum Fee of$50.00) <br /> � x .0125 $ <br /> � G� minimum $50.00) <br /> (contract price) � <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 fumished 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 '_ � � �, -,..'�,f3 _; �r,� .��:PL�;�1�11��P�R11�!'�J4;�!�'�:���4�'ffli����t��NI�NT. `.,.},�:, . , . �^ � �- ",,,Y�' <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 /> Applicant's Signature: Date: /�/'"��l�� <br /> Building Official/ Inspector: Date: <br /> Page 2 <br />