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02/14/2017 08:57 FA% 9529335049 CULLIGAN ffiVTKA 1�003 <br /> � ;��'v&:�=:�;:q- -. ;; . ..ri>4� - �e.7; p�+�'y;.pp'.i� - �,�,T _- _ ,��N;f1 _ ��i,� ,�;"e5i z�":g4 �°�'�+'� ^�� <br /> .:. .. �..y. <br /> .. � ,...F�;:�,L'J,�XI _ %At� _�7�B <br /> ., . <br /> :� ��..,: �, .s. ,����`�... : �. ��4.1�'�F�� �.� .�'�l. .�m� <br /> . �. . <br /> � . >.E. ;:', ��.._m�L�'� '� <br /> FIXTURE BSMT 1� 2ND OTHER FIX�TrPEE BSMT ��oor Floor OTHER <br /> 1YPE Floor �loor <br /> Water Closet Fioor Drains <br /> Lavatory Sewer Ejector . <br /> Bathtub Laundry Tray <br /> Shower Washer <br /> Kitchen Sink Water Heater <br /> Disposa! Water Softener � <br /> Dishwasher Wet Bar <br /> Sillcocks M9sceflaneous <br /> .� �.,�•. � .��� _4�� +r.°�'e . <br /> 1. CC1AfTRACT PRICE * is 1.25%of contract price with a (Minimum Fee of$50.00) <br /> �'p O. �� x .0125 $ J�O. ��l <br /> {confract price) (minimum $50.00) <br /> �2. S7ATE SURCHARGE <br /> x.0005 $ <br /> (contract price) <br /> 3. P05TAGE 8 HANDL[NG (Oniy on Mail-1n Applications) $ 2.00 <br /> 4. 70TAL PERMIT FEE (Add Lines 1-3 Above) $ � <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitEed work including materials, labor, profit, and other fixed costs. it is the amount to be charged to <br /> the custamer for the wark done. If any matecial, equipment, labor or installations are fumished 6y the <br /> owner, tenant or any other party, the reasonable market vafue of such items must be added to the <br /> estimated cost or contract price for permit fee purpases. In.the event tha# there is a dispute on the <br /> amount of the job cost, the City may request the subm9ssion of a signed copy of the actual contract. <br /> . - � �: : . .;�. � .8�.��'�� }����.I� _ - - - <br /> _ . , .. .. . . ... <br /> .... . <br /> i , .. F� • . ' . <br /> . �. <br /> P . ..� .:$�..^ .......i ' .. ...u. . . .. :. '... . <br /> _ 3..... <br /> The undersigned hereby applies to the City for issuance of a Plumbing Permit, agrees to do al1 work in <br /> strict accordance with the ordinances of the City and the regulations of #he State of Minnesota, and <br /> certifies that all statements made on this application are complete,true and correct. <br /> ApplicanYs Signature: Date: c�� �y ' �7 <br /> Building Official/Inspector: Date: <br /> Page 2 <br />